APPLICATION NO.______RENTAL PROPERTY: REGISTERED PENDING N/A OWNER NO. ______CONTRACTOR NO.______PROPERTY NO. ______APPLICATION PLAN EXAMINATION/BUILDING PERMIT Division of Inspections & Permits/Code Enforcement 4444 Railroad Avenue, East Chicago, Indiana 46312 (219) 391-8294/Fax: 391-7013 Important – Applicant to complete all items in Sections I, II, III, IV and IX

I. LOCATION OF BUILDING Zoning Address______District______(No.) (Street) Between______and ______(Cross Street) (Cross Street) Subdivision______Lot ______Block______Lot Size______

II. TYPE AND COST OF BUILDING – All applicants complete parts A-D A. TYPE OF IMPROVEMENT B. OWNERSHIP 1 New building 8. Private (Individual, corporation, nonprofit institution, etc) 2 Addition (If residential, enter number of new housing units 9. Public (Federal, State, or local government) added, if any, in Part D, 13) C. COST 3 Alteration (See 2 above) 10. Cost of Improvement……………………………$______4 Repair, replacement To be installed but not included in above cost 5 Wrecking (If multifamily residential, enter number of units in building in Part D, 13) a. Electrical………………………………………______6 Moving (Relocation) b. Plumbing………………………………………______7 Foundation only c. Heating, Air Conditioning……………………______

d. Other (Elevator, etc.)…………………………______

11. TOTAL COST OF IMPROVEMENT…………$______

D. PROPOSED USE – For “Wrecking” most recent use Residential Nonresidential 12. One family 18. Amusement, recreational 13. Two or more family – Enter number of units…______19. Church, other religious 14. Total floors ______20. Industrial 15. Transient hotel, motel, or dormitory 21. Parking garage Enter number of units…………………………______22. Service station, repair garage 16. Garage 23. Hospital, institutional 17. Carport 24. Office, bank, professional 18. Other – Specify ______25. Public utility 26. School, library, other educational ______27. Stores, mercantile 28. Tanks, towers ______29. Other – Specify ______

JOB DESCRIPTION (If use of existing building is being changed, enter proposed use and describe in detail): III. SELECTED CHARACTERISTICS OF BUILDING – For new buildings and additions, complete parts E-L; for wrecking complete only part J; for all others, skip to IV. E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS 30 Masonry (Wall bearing) 40 Public or private company 48 Number of Stories………………… ___ 31 Wood frame 41 Private (Septic tank, etc.) 49 Total square feet of floor area, all 32 Structural steel ___ floors, based on exterior dimensions. 33 Reinforced concrete H. TYPE OF WATER SUPPLY ___ 34 Other – Specify ______42 Public or private company 50 Total land area, square feet……… ______43 Private (Well, cistern)

F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL K. NUMBER OF OFF STREET 35 Gas Will there be central air PARKING SPACES 36 Oil conditioning? 51 Enclosed………………………… ___ 37 Electricity 44 Yes 45 No 52 Outdoors………………………… ___ 38 Coal 39 Other – Specify ______Will there be an elevator? ______46 Yes 47 No L. RESIDENTIAL BUILDINGS ONLY 53 Number of bedrooms……………… ___ 54 Number of bathrooms Full……… ___ Partial…… ___

IV. IDENTIFICATION – To be completed by all applicants

Name Mailing Address – Number, Street, City , State & Zip Telephone 1 Owner or Lessee 2. Contractor MUNIS No

3. Architect or Engineer

I, the owner or the owner’s authorized agent, certify that the information on this form, the required plot plans, and on the required construction plans is complete and accurate. I will be responsible for all work allowed by permits granted under this form being in conformance with the information on the required plot plans, construction plans, this form and all applicable laws and ordinances. I agree to hold harmless and indemnify the City of East Chicago for any claim against the City as the result of any act of commission or omission by or on behalf of the undersigned, his/her agent, principal, contractor, subcontractor, materials man, or supplier.

Signature of Applicant Address Date

DO NOT WRITE BELOW THIS LINE

V. PLAN REVIEW RECORD – For office use only

PLAN REVIEW PLAN REVIEW DATE PLANS DATE PLANS REQUIRED CHECK FEE STARTED BY APPROVED BY NOTES Building $ Plumbing $ Mechanical $ Electrical Other______VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICITON APPROVALS

Permit Date Permit Date or Approval Check Obtained Number By or Approval Check Obtained Number By

BOILER PLUMBING CURB/ SIDEWALK CUT ROOFING ELEVATOR SEWER ELECTRICAL SIGN/BILLBOARD FURNACE STREET GRADES GRADING PUBLIC AREAS OIL BURNER WRECKING OTHER ______OTHER______

VII. ZONING PLAN EXAMINER’S NOTES

DISTRICT USE FRONT YARD SIDE YARD CORNER SIDE YARD REAR YARD TRANSITIONAL YARD N S E W

FLOOD ZONE YES NO

NOTES:

VIII. VALIDATION – For office use only FOR DEPARTMENT USE ONLY Building Plumbing HVAC Electrical Wrecking Use Group ______Permit #______Fire Grading ______Date Issued______Live Loading ______Fee $______Receipt No.______Fee Waived Occupancy Load ______

Other Fee $______Approved By:

Plan Review $______

Certificate of Occupancy $______Title Date Total Fee $______IX. SITE OR PLOT PLAN – For applicant use