HomeMy WebLinkAbout05100129-Application Clay Township Permit # ?
City
of
Cannel/
I SIDENTIAL IMPROVE NT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, & Two Family, New Structures, Additions, Remodels, & Accessory Structures
BUILDER of NmE , PHONE FAX
RECORD:
BEST METHOD OF CONTACT:
OWNER:
NAME
PHONE
CITY
FAX
ZIP
.OCATION
& PRO3ECT
INFO:
SUBDMSION NAHE
SECTION
SEWER UTILITY WATER UT[LJTY ESTIMATED
PROVIDER: - PROVIDER: (EXCLUDING LAND VALUE)
NAME OF LffiUTY EXCAVATION CONTRACTOR; PLAN COMMISSION / BZA / BPW DOCKET
EPTIC
#'s (:F APmO, N--,/4
TYP - - V = :N :
[] NEW STRUCTURE
[] ROOM ADDITION(S)
# of units: ~ C] PORCH ADDITION(S)
[] M ~ [] REMODEL
,,~ ~.r.._. _.~ [] DETACHED GARAGE
~ K~.blU~:fllIAL[I'or ,~~.~.Jg,JJ. ~ ..
p I; IN ,G- A - :~ ......
[] SINGLE FAMILY
TOWN HOME
TWO FAMILY
SQUARE
FOOTAGE:
Which
Znterna~[~!~:ial:~ ~/~ndiana Amendments
· ., . "~ ~ ~ ~i'~ ~JO J
(Multi-Famdy Corlst~,~f~),'~ a~ egu/a: a s
WALKOUT Y _N
For Single Family and Two Family dwellings, additions, remodels, and/or accessory structures this ~ermit is valia ~-,- :c~-~ --
thh1180 days of the date of issuance of the building pertmt, and must be completed (Cextificate of Occupancy issued) within 18 months of the
issuance date. Class I structure ]~rmita are subject to the General Administrative Rules ~f the State of Indian' a (Se'e 675 I~tC 12) regarding expiration
time frames for beginning and completing construction.
uaa~a - -~ [~-289) aha amealdments, adopted unde~ auchonty of I.C. 36.7 et seq, Genexal Assembly of the State of ind/ana, and all Acts amendatow
thereto. I further cert~y that only k/tcllen, bach. and floor drains are connected to the sa~tary sewer. I further certify that the construction will not be
cyhas beeniss ~ ~ate
Filing Fees:
Base Inspections:
Cert. of Occupancy:
P.R.I.F.:
# Charged Re-
Reviews
Additional Fees
Community Services