HomeMy WebLinkAbout14050133 Application 4+"'ca+
`'' `�°"""�� CITY OF CARMEL / CLAY TOWNSHIP PERMIT # �
RESIDENT[AL IMPROVEMENT LOCATION PERMIT APPLICATION Sewer 1�Water Utility
�xoi�x� For New Structures�Addilions,Remodels,and Accessory Struclures pCrmit�$
� BUILDER NAM / PHONE FAX
OF �%G G�c�r'/�-, /G ��3i7J YS�'�OS'Z�
RECORD STREET ADDRE55 CI7Y S7ATE 2IP
_Z��i, ' /2�1 /1/�5v,1� /ili ��'2
E�-MAIL ADDRE55 BESf METHOD OF
i CONTACT ,'y �
l/�0 !?azS�ut hC, ro ��G✓�
PLUMBING �NAM � /� / ��/J� / STATE;OFINDIANA PLUMBINGCODE
CONTRAGTOR �/7l�L;W rl GN�q LICENSE NUMBER �3��Y7-� �[RC � UPC
i7J.XOJ
PROPERTY NAME / PHONE FA7I
OWNER I�u�a �2`�2I�C C3�-Z ��15—.��7,3
STREET�ADDRESS C STATE ZIP
rv�� � ��� �� � 33
PROJEC'f �OT NUMBER SUBDIVISION NAME SECTION
LOCATION �7O Li� � 7
STR�ET ADDRE55 . CITY S7A7E ZIP
/y� !�-� ��I l�l/
��/�R�NU�R�I�.. ��:p , ZONIf,7G � FLOOD ZON�� � .
C '4 7
1�
LOTSPLI7 SEWER�U7ILI7Y WA7E� , � SEWER/WATER
O YES � NO 1 �ILITIES EXCAVATOR
TYPE.OF �T�/'PEOFCONSfRUCfION c(DF� ' � �a11teg��2\�� � ASfERPERMI7 FLOORPLAN
PERMIT J?SINGLE FAMILY o r�1a�i{�Y� o��a�) �,S o res o No
TYPE OFIMPROVEMENT � OtSyti� ,�S . EARLY RELEASE
O NEW.�STRUCTURE F � �y�W��CHEDGARAGE O� DEMOLI710NUII.DING 0 �5 �'NO
0 ADDITION-0 Room/s O�Por ' T i
PROJECT P�N COMMISSION/BZA/BC Q�� 5 /OR ESTIMATED COST SQUARE FOOTAGE
TACDATE/5 �C1 . V! �Np�p,�`�° OFCONSfRUCTION, �`II!/�� /i/��
� EXCWDING'LAND �� �
PDFPLANS TYPE,OFFOUNDATION �MANUFACfURED SUMP�PUMP PORCH
❑ CD O E-MA[L O SLAB �BASEMENT-OWAIK-OUT 7RUSSES
- O CRAWLSPACE O:POST&BEAM � POST&7IER � YES 0 NO YES ❑ NO ❑ YES � NO
STATEOF �DRNUMBER RELEASEDA7E CONSTRUCTIONTYPE d CYCkA35 1�
Il
INDIANA
CDR SCOFEOFRELEASE E MAYL�S� ZO�'t
FORTOWNHOMES q FDN O STR O ARCH O ELEC O MECH q PLUM� Q SPKLR O OTHER
For Single Family andTwo Family Dwcllings tfiis permit is validbnly iCconstruRion commences within 1P0 day BC�the date ufissuance of this oertni and
.mus[be completed,havinpxhe Certificate o(Occupancy issued�within.l8 months oFtlie date of issuanca Class PCRetCSaTe'SUb)e'C Slate
of Indiana General Administrafive Rules(GAR 6751AC 12)regarding ezpiration timc Crames for beginning and comple[ing construction.
1;[he undersigned;agree that any construction�reconstruction�<nlargement,reloi`ation�or alteretion of a structure,or any change in[he use ofland or
structures requested by tBis aPpliwtion will comply with and confnrm to all appliia6lc laws ofthe State of Indiana and the"ZOning Ordinance o(Carmcl
7ndiana (9%° 289)an ifiicndments�adoPted ndcrauthority of I.C.364 ei sey�General Assembly ofthe State of Indiana�and all Ac[s amendatory
therem. 1 f r cer[' � at only �' �eq b th d floor drains are connected to the saniUry sewer. 1 further certify that the construction wilf not bc
used o - ied il a Ce ' (� [c of Oc syhas becn issued by the DePart ent oCCommw Se ices, armel,Indiana. `-� , _
P �'
t� = < 7��.�
SignaW re of Owner or AuMOrizeG Agen[ Prinketl Name Date
. ......... ..... ..... ......... ..... ............................................................................
. REQLIIRED'$ASE INSPECTIONS * PERMIT FEES [ '•
*Additional�insPections.may be reqwred. . FilingJ Review ��°,SA Re-Revicw
.. : Base Inspections � ���D
�: ❑ Cower Footing ��Rough-In � Fi�al _�
. �' c Cert.of Occupancy Other
:[' Q UPPer�Footing ❑ Meter Base Site
- � P.R.I.F.
��� ❑ IIuderslab �`�rj I,OO
: �� TOTAL
:` s.-z} -1'� : : �nim � ��� �1�� :
Rev�ewed/,.Releaed DePartmen[ofCommimity5ervices a[e � ; Fee—�R ceive`A-De tm toP ommwicyServices DetC ;
` ........ ..:.::... �` .i...........:........... ...�:...�......i r...................6..... ..........................................................:.......r
ms41pp1icaiionsViwidentia➢ll.P AppliwtionV,009�08 Last Updazed 0&I V2009