HomeMy WebLinkAbout05110046-RevisionREVISION / PL..AN.AlVa..NDMENT or ADDENDUM to sTATE RELEASE
For Commertc!al, Institutional, Industrial, or Multi-Family Projects
City of Carmel; Department of Community S~rvices
--
ssued: ~ Yes __ No. If yes. PERMIT #: ~
BUILDER of
RECORD:
NAME: PHONE
STREET ADDRESS: CITY:
BUILDER'S EMAIL ADDRESS:
ETATE: ZIP:
BEST METHOD OF CONTACT:
LOCATION PRO]ECT NAME: LOT ~ and SUBDIVISION NAME: (If aanllcable)
& PROJECT ~( ,' ~ - ~l
INFO: ADDRESS OF CON~U~ON:
NEW SQUARE FOOTAGE OR J U~ E~MA~D CO~. ~~ON WPE: ~ S~B ~ C~WL SPAC~
O~ER(S):__ ~
~ of Fl~m: ~ .; Elevator/U~: g YES ~ NO BLDG. CON~U~ON ~PE: ~_ ~ OCCUPANCY ~SSlFI~ON: ~
~OF AMESDMEST/REVISIO~t AND/OR ~ATE RELE~E ADDENDUM/UPDATE I~FORMA~ON:
Class I structure permits are subject to the General Administrative Rules of the State of Indiana (See 675 lAC 12) regarding expiration time frames for
beginning and completing construction.
I theundersi, ed_, agree that any :onstrucuon reconsrractkin, enlargement, relocation, or alterationofasrrucmre, or anycbangeintheuseoflandor
structures requested by this appkication wilt comply witk and conform to, aL1 applicable laws of the State of Indiana, and the "Zomng Ordinance of Carmel
Indiana - I993" 7~289) and amendments, adopted under authority ~£ LC. 36-7 et seq, Genera[ Assembly of the State of indiana and ail Acts amendatoty
thereto. I also certify that ordy kitchen, bath, and floor drains are connected to the sanitary sewer. I further certify, under the penalties of Perjury (Indiana
Code 35-44-2-1) that all of the information [ have provided in this Application and other documentation is true and accurate to the best of my
knowledge and belief, and that 1 have not knowingly or Lntentionally provided or omitted any information that would tend to hide. obscure, or
otherwise mislead the Dept. of Community Services regarding the truth of the matters addressed. I also agree that the construction w~l not be used
or occupied until a CerrLO~at'e o[Occupa~c?has been issued by the Department of Community Services, Carmel, Indiana.
Print Date
NEW INSPECTIONS REQUIRED: ~5 e
Vjt~}~.A_ PLAN AMENDMENT/REVISION FEE:
0','
under
i~{(ADDTT~ONAL SQUARE FOOTAGE
Upper Footing Lower Footing Slab ~bo~'fa'
~- NEW INSPECTIONS REQUIRED:
Rough In Meter Base Final Site (If additional inspections other than what already remain on the existing permit are r luffed.)
· . TOTAL: .