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2. The Town of Zionsville, Indiana
   1100 West Oak Street, Zionsville, Indiana 46077
   Application for Improvement Location Permit, Multifamily, Commercial, Industrial
4. Site Information:

   1. Rural

   1. Urban
6. Address of Property:
7. Name of Subdivision/Development:
9. Lot Number:
10. Zoning:
11. Parcel Number:
13. Existing Use:
14. Health Department Permit Number:
16. Proposed Use:
17. Drainage Permit Number:
19. Area of Lot:
20. Driveway Permit Number:
22. Applicant (Builder-Contractor)
23. Property Owner
25. Name:
26. Name:
28. Address:
29. Address:
31. Phone Number:
32. Phone Number:
34. Email:
35. Email:
37. Project Information
39. Use:

    1. Mult Family
    2. Commercial

    1. Industrial

    1. Demolition

    1. Other
41. Other (Describe)
43. Number of Units:
44. Number of Buildings:
46. Type of Construction:

    1. New

    1. Addition

    1. Other
48. Other (Describe)
50. Area of New Construction:
51. Area of Existing Structures:
52. Total Area:
54. Estimated Cost of Construction:
56. Road Impact Calculation Sheet:

    1. Included

    1. N/A
58. Plumber:
59. Plumber License No.
61. Set Backs
63. Front:
64. Side:
65. Side:
66. Rear:
68. Parking/Loading:
69. Front:
70. Side:
71. Rear:
73. Maximum Height:
74. Required Number of Parking Spaces:
75. Parking Spaces Provided:
77. Floodplain Data
    (To be completed only if the site is within a 100 year flood plain)
79. Elevation of 100-year Flood:
80. Minimum Flood Protection grade:
82. Minimum Flood Protection grade:
83. First Floor elevation above mean sea level:
85. An elevation certificate signed by a land surveyor, engineer or architect is required if the site is located in a flood plain
87. Lead Based Paint

    Per the Indiana Administrative Code 4101AC 32 and U.S. Code of Federal Regulation 40 CFR I acknowledge that have reviewed and if necessary have submitted all necessary information to the Indiana State Department of Health regarding lead based paint that presently exists in this structure.

    1. Yes

    1. N/A
89. Fire Department Information – Fire Suppression / Fire Alarm Systems
91. Fire Alarm System included in this project:

    1. Yes

    1. N/A
92. Fire Alarm Suppression Systems included in this project:

    1. Yes

    1. N/A
94. If your project or the project area contains a Fire Alarm, Sprinkler System, Kitchen Hood System or any other Special Hazard System, please contact the Fire Marshal at 317-873-5358.
96. Signature*

    The undersigned hereby certifies that the above information is true and correct as (s)he is informed and believes and agrees, that as a condition of making this application and of its issuance, to conform to the building code of the Town of Zionsville and all instructions and directions of the Building Commissioner and Inspectors and further that the improvements authorized by this permit will not be used or occupied until a certificate of occupancy has been issued by the Town of Zionsville, Indiana.

    1. I Agree
98. Today's Date
    Today's Date
99. Name
101. Road Impact Fee Estimate Request
     In addition to information identified on the project site plan, the Town of Zionsville requests the following supplemental information for purposes of calculating a Road Impact Fee estimate for the project referenced below. If any of the Project Information below is modified or changed, the impact fee may be adjusted to reflect the change.
103. Proposed Site and Floor Plan*
105. Location of Proposed Activity:
107. Address*
109. City*
110. State*
111. Zip Code*
113. Lot Number:*
114. Zoning:*
116. Subdivision:*
117. Present use of Property:*
119. Owner of the Premises Where Proposed Activity Will Take Place:
121. Name*
123. Address*
125. City*
126. State*
127. Zip Code*
129. Phone Number*
130. Email Address*
132. Project Information:
134. Land Use Description:*
     Identify any existing or proposed land uses or any expansion of existing usages. (Please be specific).
136. Project Size / Area*
     Indicate the acreage of the entire project site and the square footage of all existing and proposed buildings and structures. Specify square footage dedicated to individual activities within the site/buildings. You may use the back of this sheet to illustrate.
138. Number of Employees*
     Indicate the total number of employees to be located at the proposed site. Include existing and future employees.
140. Hours of Operation*
     List the hours of general operation, including anticipated deliveries or other site support services.
142. On-Site Parking*
     Indicate the total number of on-site parking spaces intended for use by employees, customers, and deliveries.
144. Anticipated Deliveries*
     Indicate the average number of deliveries made to or from the proposed site in a 24 hour period.
146. On-Site Facilities*
     Indicate the existence and capacities of any on-site food services or vending facilities that enable employees or visitors to prepare and eat meals on-site.
148. Surrounding Facilities*
     Indicate the number of and identify all businesses or facilities adjoining the proposed site.
150. Certification:*

     I hereby certify that I have the authority to make the forgoing application and that the application and accompanying site plan are correct.

     1. I Agree
Leave This Blank:


152. 1. Receive an email copy of this form.
153. Email address

     This field is not part of the form submission.

154. Submit

* indicates a required field