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Property Intake Application (E-Form Submission)

2. 

4. BASIC INFORMATION

6. Project Name*

7. Date Submitted*
   Date Submitted

   Date Submitted

9. Project Address*

11. City*

12. State*

13. Zip Code*

15. Signature*

    (Type your name)

16. Form Submitted
    Form Submitted

    Form Submitted

18. CONTACT INFORMATION

20. Owner/Organization*

21. Telephone Number*

23. Contact Person*

24. Email Address:

26. ARCHITECTURAL INFORMATION

28. Architectural Firm

29. Telephone Number

31. Contact Person

32. Email Address

34. PROJECT MANAGER

36. Project Manager

37. Telephone Number

39. Contact Person

40. Email Address

42. The following documents will be needed when submitting this application.*

    1. Proof of Ownership
    2. Parcel number(s):

44. Please provide complete list of Parcels.

46. BUILDING/SITE DESCRIPTION

48. Class 1 Structure? (Select one)*

    1. Industrial
    2. Commercial

49. Is the project in a Flood zone? (Select one)*

    1. Yes
    2. No

51. RESIDENTIAL

53. Residential (Structure)
    -- Select One -- Existing Structure - YES New Structure - YES Other

54. If "yes," specify the following:

56. Describe type of Residential Structure.

58. No. of dwelling units?

59. Gross floor area (sq. ft.)

61. COMMERCIAL

63. Commercial (Structure)
    -- Select One -- Existing Structure - YES New Structure - YES Other

64. If "yes," specify the following:

66. Describe type (retail, office, etc.)

68. Gross floor area (sq. ft.)

70. INDUSTRIAL

72. Industrial (Structure)
    -- Select One -- Existing Structure - Yes New Structure - Yes Other

73. If "yes," specify the following:

75. Type of use

77. Gross Floor area (sq. ft.)

78. Open Storage area (sq. ft.)

80. If any unenclosed activities, specify:

82. OTHER - Land Use

84. If "yes," describe:

86. PROJECT VALUATION/FUNDING

88. Estimated Dollar Valuation of Project:*

90. * Please note that all personal information submitted to the City of East Chicago is confidential, to the extent permitted by law.

92. DEPARTMENTAL USE

94. Date Received*
    Date Received

    Date Received

95. Ref/Initials*
    -- Select One -- CD-Courtnee Dinkins ECR-Esperanza Ceja Ramirez Other

96. DEPT APPLICATION NUMBER*

98. Lot Fronts on (Street Name)

99. Data Research Date
    Data Research Date

    Data Research Date

101. Lot:*

102. Block*

103. Section*

105. Range

106. Township:
     North

     North

107. County
     Lake

     Lake

109. TECHNICAL REVIEW DATE:

111. Additional Comments:

113. PLANNING COMMISSION DATE:

115. Additional Comments:

117. BOARD OF ZONING AND APPEALS (BZA) Hearing Date:

119. Existing Zoning:*
     -- Select One --C1 - NEIGHBORHOOD RETAILC2 - GENERAL COMMERCIALC3 - NORTH HARBOR BUSINESS DISTRICTM1 - LIGHT INDUSTRYM2 - HEAVY INDUSTRYP1 – PARKSR1 - SINGLE FAMILYR1a - SINGLE FAMILY, SEMI DETACHED DWELLINGR2 - TWO FAMILY DWELLINGR3 - MULTIFAMILY DWELLING TWO STORY ROWHOUSER4 - MULTIFAMILLY DWELLING THREE STORY OR LESSWD - WATERFRONT DEVELOPMENT

120. Proposed Zoning
     -- Select One --C1 - NEIGHBORHOOD RETAILC2 - GENERAL COMMERCIALC3 - NORTH HARBOR BUSINESS DISTRICTM1 - LIGHT INDUSTRYM2 - HEAVY INDUSTRYP1 – PARKSR1 - SINGLE FAMILYR1a - SINGLE FAMILY, SEMI DETACHED DWELLINGR2 - TWO FAMILY DWELLINGR3 - MULTIFAMILY DWELLING TWO STORY ROWHOUSER4 - MULTIFAMILLY DWELLING THREE STORY OR LESSWD - WATERFRONT DEVELOPMENT

122. Additional Comments:

Leave This Blank:


124. 1. Receive an email copy of this form.
125. Email address

     This field is not part of the form submission.

126. Submit

* indicates a required field