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* + � CITY OF CARMEL / GLAY TOWNSHIP PERMIT # S '
� � �RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION Sewer / Wa er Utility ,
�nuux� For New Structures,Additions,Remodels,and AcccssoryStructures Permit$�
BUILDER NA ` VHO FA%
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RECORD �REETADDRESS � CITY S7A7E ZIP
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E-MAILADDRESS (��\ ` BEST METHOD OP �
Ot�r-O�� W V' �C�/�—U.. [-C��^'\ CONTACT eU..C"�l `
PLUMBING NAME SfATEOFINDIANA P UMBINGCODE
CONTRACTOR S� w`�\, � LICENSE NUMBER p�����a _ _/4 ��
4Y�H�
PROPERTY N (— � PHONE FAX
OWNER � � c�-1 — t ��,. ��'�7 �yb�� aa
ST EET ADDRE55 CITY STATE ZIV
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PROJECT �O7 NU SUeD SION NAME SE ON
LOCATION �� MC0.�04:5 G.'� � �G
STREET ADDRESS � . CITY E ZIP
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T�P PARCE��BE� �O ZON[fi�� .'� - FLOODU �ES�'14�I
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LO75PLI7 5 ERUTILITY SEWER/WATER �
� YES NO
N �Q r UTILITIES EXCAVATOR ��l U
TYPE OF TYPE FCONSTRUCfION MASfERPERM�IT� FLOORPLAN
PERMIT 1NGLE FAMILY � NJO FAMILY Q TOWNHOME q YES �fJO
TYP FIMPROVEMENT EARLY RELEASE
NEW STRUCTURE � REMODEL O ATTACHED GARAGE O ACCESSORY BUILDING
O ADDTf[ON-O Room/s �q Porch O Deck q BASEMENT FW[SH q DEfACHED GARAGE � DEMOLIT[ON q YES
PROJECT P�N COMMISSION/BZA/87W DOCKE7 NUMeER/S AND/OR ESTIMATED COST SQUARE FOOTAGE
TACDATE/S OFCONSTRUCTION� 1�/ _ � �{�'�
� EXCLUDING��UIND v{ J
PDFPLANS TYPE OFFOUNDATION MANUFARURED SUMPPUMP PORCH
❑ CD �MAIL � SLAB 4�1lSEMENT-q�WALK-OUT 7RUSSES
Q CRAWLSPACE Q POST&BEAM O POST�&PIER ES C� NO YES � NO �Q NO
STATE OF . �DR NUMBER RELEASE DATE . CONSTRUCfION TYVE OCCUPANCY CWSS
INDIANA _ � �
CDR �OPE OF RELEASE � ([,YPE,jOF pELEASEJ � I
FORTOWNHOMES� Q FDN O STR � ARCH L7 ELEC O L, \9 IS
. .�$11��CtQb E��I�IC�'�1�2�f Z�1
o a e an oca Codes �
For Single Family and Two Pamily Uwcllings this permit � i � �� n I80 s f the da[e o(issuance o(this Pe rt and
must Ae com lered,havin the Ccrtifivate of Occu an[�j�I� �IA���vh[n)�{',��',7f}����pqTT�ryNp Q� CI ss 1 Struclurc Permits are sub'ecl[o he S�a[e
of IndiSna C neral Admingstrative Rules(GAR 6751AC 12�regarding cxp af�dn'lTmt itad�M C8 ��'lhing a d tomPleting ro struction. ,
I�the undersigned�agFce that any mnstruction�reconstruction,enlarge���t��tion{or alteration ofa st ��_�__thE'� nd or
muaures requcstcd by this application will comPly with and conform�to all applicable la��s uf the SGte of I e .oning brdinanee ofCarmel
India`u-1993^(Z-289)and amendments�adoPtcd undcr au[hori[y uf I.C.36-0 et se9,Genenl Assembly ofthe Statc of Indiana�and all AcYS amendatory
urther ee '(y that oni�kiteheu -a and Ooor drains are connceted to the sanibry sewer. 1 Cunher certify ffia[the cons ruction will not he
us occu ' d unti �Certifia ts c� c ip c has bcen issued by the Departmen oFComm nity Servit„r5 el�lndia
C�2 � ��
Signature rA� hon gent PrintatlName Data
�.............:.....................�................................................... . _...
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REQUIRED BASE INSPECTIONS * � PERNIIT FEES
� c Filing/Review I�,�-�3 Re-Revie�v
Additional inspections may be reyuired.
���^^^ : Base Inspections Z s�
ower Footing �Rouph-In �inal
E Cert.of Occupancy E�3•SO Other
:�PPer Footinp Meter Basc ❑ Site
\ : P.R.LF. •�
� ❑ idersla
ToTn '31�i3 .o3
/ 6 a !
; Rerie /Releazed- epartmen[olCommuNty Services I ce ; Fee Recciv —Depanment of Community$ervices Ja[e ;
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