HomeMy WebLinkAbout14050080 Application `�y��� CITY OF, C?iRMEL / CLAY TOWNSHIP PERMIT # �� 05��
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RESIDENTIAI;:IMPROVEMENT��LOCATION PERMIT APBLICATION Sewer / Water Utilitp �
• .��.oiFxP For New Structures,qdditions,Remodels,and�Accessory Structures Permit�$ �����jV
BUILDER' "^ME PHONE FAX
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REGORD �sTR€ET,aoogess cro srare na
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E-MAIL ADDRE55 BESf�MEfNOD OF
A� Cw�'�OwN CONTACT
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PLUMBING NAME I , / STATE OFQNDIANA PLUMBING CODE
CONTRACTOR JMF�L �p�,q/���Nb Wl„� �ICENSENUMBER 110 O IRC �( UPC
PROPERTY NAME PH�O'NE� FAX
OWNER IZ�Gtt4�D NO NIJ �EN�)E2U'�1E LJ2���I- ?
STREETADORE55 -' CI � STATE ZIP
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PROJECT LOTNUMBER SUBDIV[SION'NAME SEGfION
IOCATION I �gS�E�v��
STREET ADDRE55 . CITY STATE ZIP
? y lsf l�E NvJ c�nE� ►� a 3Z
TAX MAP PARCEL NUMBER ZONING FLOOD ZONE/S
�b� ^Z.S-0$�(o"OO1 , 00O p
LOTSPLIf SEWERUTILITY WATERUTILITY SEWER/WATER "
q YES q NO GRrL�IEI. V I IU T��(�5 U7ILI7IE5 E%CAVATOR � `
ltxJ�T 1 oN �X�4�4TTO�
TYPE OF TYPE OF CONS7RUCfION MASTER PEfiMif FIOORPLAN
PERMIT �SINGLE FAMILY 0 TWO FAMRY O TOWNHOME q YES N0
�TY EDFIMPROVEMENT EARLY RELEASE
NEW STRUCTURE � REMODEL O A7TACHED GARAGE � ACCESSOftV BUILDING
O ADDITION-O Room/s O Por�h 0 DeCk q BASEMENT.FMISH q DETACHED GARAGE 4 DEMOLITION ❑ YES NO
� PROJECT P�N COMMISSION/BZA/BPW DOCKEf NUMBER/S AND/Ofl ES7IMATED COST u 5 UARE FOO7AGE
TAC DATE/5 %OF CONS7RULTION,�(y�n' �� � n �^ I
� EXCLUDING�LAND n j'j � V (
pDFPLANS TYPEOFFOUNDATION MANUFACfURED SUMPPUMP POkCH
� SLAB M BASEMENT-O WALK-OUT �TRUSSES
❑ W O E-MAIt `�
q CRAWLSPACE O POST& M 0 POST&PIER Q YES NO YES O NO YES � NO
STATE OP �DR NUMBER RE f�R�� CONSTRUCTION TYPE OCCUPA CY CLASS
INDIANA s�blect'roco NSTR T
SCOPE OF RELEASE � fe���OnS -OF L E
CDR (��p Stdt�and( p������
FORTOWNHOMES O FDN q STR O ARCH d!��LT[�� ' "C2"9VCQR q OTHER
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Por Single�amily and Two Family.Dwcllings this Permit isyalid�] 5,q, �c - s within 1 BO day of the date of'.issuance of this Permi and
must 6e completeJ,havinp the Certifirate of OccuPancy issueel!li��dR.onths ofthe a � of issuanee. Class Stru�YUre Purmits are subject to th SUte
oflndiana Gcneral Administra[ive Rulec(4AR 6759AC 12)rcgar8in�expiration time frameh for beginningand �p Icting conslruction. ,
I,ihe undersigned�a�.ree ffiat any construction,remnstrucYion,enlar�+emcnt�relocation�or alteration of a stru �Y i ur
strunures requcsted by this appliiation will comPly with and conCorm to all applicablrlaws of the State of Indiana and the°Zoning brdinance oFCarmcl
Indiava-�I993"(%�,289�and amcndments�adoPtcd undcr anthori[y of I.C.36-7 et sey�Gcneral Assembly ufthc State of Indiana�and all Avts amendatory
�therem. 1 Curt r certify-ih, onl��kitchen�bathqand floor drains are connected[o tfic sani�ry sewer. 1(urthcr cctti(y ffiat Ihc construction will not bc
used o�oce ed until a �t � epCOccu avcy has 6ecp iseued by the Depathnent oCCu unity Services.Carmel��Indiana.
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SignaW W wnerar oriz pgent Pdn[ed Name� - Date
�......................................................................................� ;.............................................................................................�
REQLiIRED BASE INSPECTIONS * � PERMIT FEES �j
* : Filing/ Review �� ° • ��
Additional insPections may be reynired. ^ R�Review
i Base[nspections 0��. °
�Lower Footing �Rough-[n �Final ; Cert.of Occupancy � Other
Upper�uutin _ �,Meter Base ❑ Site l I .,�q �
'�P.R.I.E. � � VJ
� ❑� Un� r lab� r � G/
' OTAL � l�p .07
;�.ftx��e�ed" � sed De .. e .(. m�numt Sern:es U � � ��/' �� •
� - ' } � Fee lieceiverl Uepart.eo[o( 'ommunity Sermce� U2[e �
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