HomeMy WebLinkAbout05110119-ApplicationRECORD:
OWNER:
& PRO3ECT
INFO:
Permit #:
Township
IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, & Two Family: New StruCtures, Additions, Remodels, & Accessory__StruCtures
NAME ~ ~
STREET ADDRESS
( '._
BUILDER'S EMAIL ADDRESS
E
STREET ADDRESS
.Ot # SUBDIVISION NAME
ADDRESS OF CONSTRUCTION
PHONE FAX
CONTRACTOR; PLaN COMMISSION BZA BPW DOCKET
OR COUNTY WELL AND/OR SEPTIC PERMIT #'5 (IF APPLICABLE):
CITY STATE ZIP
ZONING:
SECTION
SQUARE
FOOTAGE:
ESTIMATED COST OF CONSTRUCTION:
(EXCLUDING LAND VALUE ~.~4-~2~
p - ~- UCTION:
[]~ SINGLE FAMILY
[] TOWN HOME
[] TWO FAMILY
~ of units:
[] MULTI-FAMILY
# of Units:__
TYPE OF IMPRO--EMENT:
C~ NEW STRUCTURE
[] ROOM
[] PORCH
C~ REMODEL
C3 ACCESSORY BUILDING
C] DETACHED GARAGE
PLUM
Which plumbing
~ational Residential Code w/Indiana
Amendments
.Date)
Base Inspections:
Cert. of Occupancy:
P,R.I,F,:
= Charged Re-
Reviews
TOTAL:
Additional Fees
Under Slab
,RED:
[] RESIDENTIAL (For [] ATTACHED GARAGE . ~. C~ Uniform Plumbing Code w/Indiana Amendments
Additions Remo~L~ED F:C~ T~C~' (Multi-Family Construction Code)
R E IN RM ~tto~omp~cewth~ r~ ~ ' · for~enew
. g ~ns FOUNDATION ~PE. (Check ali ~at apply
Lot Split: ~p ~ ~B (~ ~ BASEMENT
Does any pa~ of the p~pe~ lie ~a~cial Fiood designation a~a. y ~ WALKO~:~Y~
~t~n 180 da s of the date of ~ssuance o[ the ouumng per.t, ano m .s. · * ' ' ee 675 IAC 12~ re~ard]n~ e ~rat~on
time frmes for ~ginning and completing construction.
' · e rha~ ~ consrrucrton reconstruction e~argemenL retocanom or ~rrr~rion of a sr~c[ur~, or any c~ang~m ~e ~se
l, the undersl~5~~ ~s a~'~ arion w~ com~lv wStb. ~d con'om [o ~ appBcablc laws o[ the State of [n~ana, a~d the Zomg Or--cc of C rmd
hereto, l[urrhercerd[yd~aronty~tchen, barh ~dfloor~ainsareconnecredrct~esanirary~wer ifurrhc[cerrffyrhatthe?nsrrucr~on~lnorbe
[ - ~'-~-'nri~a C~r~carc of Occupancies been issued by the Departmem o[ Community Se~tces, C~mel, l~dlana,
...... Filing Fees: