HomeMy WebLinkAbout030042-ApplicationBUILDER
OWNER
Permit No.
Improvement Location Permit Date
Roll File
within 180 days of the date of ~ssuance for residential construction; and for commercial
n Release. All construction mus
PHONE FAX
CIT~ STATE g~
Bl ,e 14or e hve
LOT
PHONE FAX
~OZ2 (~3f7) 573 -
SECTION
1. ~' Public (Name of system~
2. [] Private(Countype~mit#~
C WATER ~.
1. ~ Public (Nameofsystem__~.~__~)
2. [] Private (County pe~t # [k] ~
D, ZONING:
E. ESTIMATED COST OF CONSTRUCTION
(Excluding Land Value)
(Print)
E-Mail:
Plan CoTssio W Docket #'s; T~C Date(s)
Re iewed/Approved: Dept. of Community Services
F. TYPE OFIMPROVEMENT
1. [] New Structure
2. [] Addition: Porch Room
[] Commercial ~ Space
[] Foundation Only
Demolition
[] Garage Detached Attached
NO
3. Lot Split YES __
H. Flood Zones YES NO
I. Sump Pump YES N(~
I. Manufactured Trusses YES N
K. Plumbing Contractor t30
IRC Plumbing Code: [] Plumber's
Indiana Plumbing Code: [] License #:
t change in the use of land or sumctures
g ~ce of carmel Indiana - 1993"
e of Indiana, and all Acts amendatory thereto I further
r certify that the construction wffi not be used or oc~ until a
INSPECTIONS NEEDED:
~ Meter Base
Site
Fees:
Base Inspections:
Cert, of Occupancy:
P.R.I.F.:
r~nits/Forras/II~5 -02