HomeMy WebLinkAbout14060011 Application `��y�� CI-TY OF CARMEL / CLAY TQWNSHIP �tMIT # ��I�6 0e��
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATI� Sewer / Water Utility
�o��p'.�- For New Structures,Additions,Reroodels��and Accessory Struclures Permit# I��I,0 60 0�Z �
BUILDER NAME PHONE FA%
oe '2�v1 � �' � 3� - 33��13g 3l9 -�5Z-31d3
RECORD �TREEf ADDRE55 - CITY STATE ZIV
9 900 �✓c'�95a � �cw�sbo e �/ � ri z�
E-pMAIL ADDRE55 BE HOJD OF/� —y]
1�✓.VI ���5 � �GDIw��. � CONTACT JI�/��J`I—�I3�
PLUMBING NAME STATE OF INDIANA PLUMBING CODE
CONTRAGTOR LICENSE NUMBER
c I O�Op 1 D I 4 �RC o ux
PROPERTY NAME PHONE r�_ FA7(
OWNER � c �, i - RS-3(D2 (0�0 -230-10'72
SfREEf ADDRESS CITY `� I�"SPA�E,'���—�— ZIP
io9 ss �v�( �lp� s,�d; �(s � �:l,��`1 �� Z�
PRO]EGT �OT NUMeER SUBDIVISION NAME ' SERION
LOCATION � 8 S 'e Wl LJ MAY 3 0 ��; (�(
STREEfADDRE55� /i„�N�/� CITY STATE ZIP
09'S!#�a a �'/09 5/�`-// �-"�� .�w ' �'n�/ Z Z�
TAX MAP VARCEI NUMBER ZON 20NE/
l�7-r3-o-03-02-o B, a �3 x u �
LO75PLIT / SEW RU7ILI7Y WATERUTILITY SEWER/WATER
0 �S J NO C�. �// , � UTILITIES EXCAVATOR O/ � /���
�7 7d�/� Z7 l
TYPE OF PE OF CONSTRUCRON MASfER DERMI7 FLOORPLAN
PERMIT SINGLE FAMILY O FAMILY 4 TOWNHOME q YES O NO ��
PEOFIMPROVEMENT EARLY RELEASE
Q NEW�STRUCTURE O REMODEL A'iTACHED GARAGE ❑ ACCESSORY BUILDING
Cl, ADDIf10N—O Room/5 O Porch O Deck q BASEMENT FINISH O DETACHED GHRAGE � DEMOLITION 0 YES O NO
BROJECT P�N COMMISSION/BZA/BPW DOCKEf NUMBER/5 AND/OR ESTIMATED COST SQUARE FOOTAGE
TAC DATE/S OF CONSTRURION, ��J�(� 60�.(,
� EXCLUDING LAND � �� JlD' ( U N 1
PDFVLANS T�YP OFFOUNDATION MANUFARURED SUMPPUMP PORCH
❑ CD � E-MAIL "' "�g 4 �EMENT—Q WALK-OUT 7RU5 � �
0 CRAWLSPACE 0 POST&BEAM ❑ 0 O YES IY NO 4 �S NO
STATE OF �DR NUMBER RELEASE DA7E D N ON TYPE OCCUPANCY C1A55
INDIANA
SCOPE OF RELEASE A,�(�Y 5 po TYPE OF RELEASE
ODR OWNHOMES � FDN Q STR O ARCH 4 ELEC 4 ME PLUM'Q �KLRLO'OTH
ForSinglcFamilyandTwoFamilyDwdlingslhiePcrmitisval' ,f lsucF�»t+�emn inl80daysofthcdatco(issuanceo(thispertnitand
must be mmPleted�Faving the Certilira[e oLOcc �n mon[ s o(lfie date of issuance. Class 1 Strucfure PertnLLS are subject to the State
of Indiana General Administrativc Rul r�aap��Q�piration time frames for beginning and completin�mnetrvc[ion.
I,the undcrsigned,agree thac a � �_n,�nr� ��of,,�enlargeme t�relova[ioq or altera[ion o(a stru�YUre�or any change in the use ofland m
strunures reyucstcd by this ap�i'�i�{��7NS ���'�o ��1 applicahlc laws uf the State of Indiana and ffie'Loning brdinance ofCarmcl
�Indiana—1993^("L-289)and amend�ents,a�y��n �ry�y'�os ��{{� t seq�Ccneral Assembly o(thc Sta[e o(lndiana�and all AcYS amendamry
thereto. 1 further eertify.[hat only krtche �'d��!'f y� tft�d to the saniGry sewer. ITurther eertify tha[the construction�vill not be
�used ^until a rtifin(qFi�c��a�b�c��S�AEd,by the De ment o(Com�i[y Sen�ice',�;armel India��� � �
/�e v,a,.v�-�1E �A�g�A ��I�cs�e i%vr i wt�Y�c- S �
gemm.e-o..sw 3 Mnte�Name �a�
�......................................................................................a :.............................................................................................�
REQLIIRED BASE INSPECTIONS * '• PERMIT FEES
*Additional inspections.ma��bc re9uired. E Filing/Review ���a .�� Re-Revicw
J � Base Inspections ��
: n. 1�e��er Footing �Rough-In J� Final �
J ,_,// ,�/ c Cert ofOccuPancy Other
: � li cr Footing YJ Meter Base IG Site 1 �-7 q �
� ( � P.R.LF. ! � �J
:� ❑ nderslab q .q I
TOTAL i
�`a��.; .�%15�—� /,./o�� : : � � I
� Iteviewed/Rel� —I epartmentu(Commm�i[y5ervices' Uaze • � Fee teceived— e ttm 'tof ommunityServires Uate
i...............................:6..........:......:................... .............i i...:...::�.....................................................................................i
SiPamus�PUrme\Applica�ionslRCaldurtleNLP Appllcaiioo@009-08 Isn Opdaled OWI32009�
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