HomeMy WebLinkAbout14060015 Application 1' =/r4.
CITY OF CAKMEL / CLAY "I�OWNSHIP PERMIT # lya`00 �s
COMMERCIAL/INSTITUTIONAL IMPROVEMENT LOCATION PGRMIT APPI,ICATION
��r�.�� For NeH�Slructures,Additions,Tcnanl Finishcs, Remodels,and Acccssorv Struclurc+
BUILDER PHONE r FAX
OF C ' S i uC D �.I � � '/(�i�J
RECORD �RE�DRE55 � CIfY S7A7E
C% �
E-MAIL ADD E55 p e��r�n u� ��` gEST METHOD O
. CONTACT �S �/����^
Q 'PGIJS �
PLUMBING NAME STATE OF IN IANA
CONTRACTOR L F �zL LICENSE NUM6ER
PROPERTY N E � PHONE FA%
OWNER � S ,C[+
STREE7 ADDRESS � C y7 71p -
SD Q3 3
PRO]ECT P 7ER OR ENANT COMPLE D/OR BU DING NUMBER OF FLOORS ELEVATOR
LOCATION ( � O YES �o
TAD 5 NCLUD SUITE MBE /�IfY STATE IF
S� �� � 33
HAMILTON COU TV PARC NUMBE ZONING FLOOD ZONE/S
aa o v sj � � � .
LOT SVLIT �,� SEWJ�UTIIITY, WATER UTI � ra �� E R
❑ YES DO NO l� 'u L� VATOR
�
TYPE OF T�'P F CONSTRU�C/TJp n III�� n n'Q Numter or unirs
PERMIT COMMERCIAL LJ INSTITUTIONAL-❑Munici I ublYc�BGiNdidg�5ch0ol rch ❑ MULTI-FAMILY
EARLV RELEASE TYPE OFIMPROVEMENT
❑ YES ❑ NO � NEW STRUC7UR�[� �-� ❑ W TENANT FINISH ❑ ATTACHED G RAGE ❑ACCESSORV BUILDNG ❑ CELL TOWER
❑ADDITION-�RbFk1,l{YS���c� � DETACHED G RAGE O DEMOLITION O CO-LOCATE
PRO]ECT P�N COMMISSION / � lY�1�IR�{�jR}����l��OnS �OR ESTIMATED ST SQUARE FOOTAGE
TAC DATE/5 ot State and�oca! OF CONSTRUCTION,f /��-� d�� DO
r(� p,��};{�µ-}C�oC-(F,�s EXCIUDING LAND
PDFPLANS �TYP OFFOUN 6 �-"`��'�'IUiYII I J[�ES MANUFACTURED SUMPVUMP PO CH
❑ l.D ❑ EMAIL '�" '�B � P �}/��A���p�� TRUSSES
❑ CRAWLSPACE ❑ POA �'P�STrBlFRtlK7IP ❑ YES ❑ NO ❑ vE5 ❑NO ❑ YES ❑ NO
STATE OF �DR NUMBER REL CONSTRUCTION TYPE OCCUPANCY CLA55
INDIANA s d —
CDR SCO F R ❑ HOOD PE OF RE EASE
❑ FDN STR ARCH LEC MKH❑ LUM ❑ SPKLR ❑ OTHER
Class 1 sUUCturi� ��crmits are subjcct to thc Statc of InJiana Gencral Administra[icc Rules(GAR 675 IAC 12)rcgardin�
c���iratiun timc Il.imcs li�r be�innin�+and cum�ilrtin�consirucliun.
I.ILemidersiKneJ.a�rerthatanca iutrui'�iun.re<'onslrurlion.rnlar�.emenl.reloiation.ural[eralionu(a.Iructure.urancchanyein�hcuseol'IanJor
,truilurrs requesteJ br�hi>a�>plication arill mm�ilc.cith and i'on(urm to all applicable laws ul�he ti�ate ol'Indiana anJ the•7uninK Ordinance o(Carmel
Indiana-1993°(/-289)anJ amenJmrn�s,adu��ICJ undcr a�tlhorih nl'LC.3fi-7 rl se��,Gencral A.�sembh'o(1he�tale uf InJinna,and all Ai'�s amendatun�
�6vrelo. (ur ffy i'ertil;v hi i Iv ki4 �6.6alh.and Iloordrainnare cunnecicd u thi� -inilan�se�vi•r. I furt �rcerlilb�ha�th��onnNru<liun will nu�be
.r I o uca � fl until. J1jr�ate o irupancv or ol tiubs[antial Cum�Ie� nn �; •i i>sued 6� f D lwent o(Communih'tierviae�,Car I.I di. "a.
� ignatu otOw rorAUthor tlAgen[ �� Prinh ame � � D e �
.......................................................................................y ,..............................................................................................,
REQUIRED BASE INSPECTIONS * '• PERMIT FEES
*Additional ins��ections may be rcyuired. : Filin� / Re��iew Z .5� Ro-Recie�c
[ Basc Ins�>ections 3�•�
i ❑ LowerFoo[ing �Rou�h-In I�Fire ; CerLOfOccu�ancy (�•�O O[her
j � U���cr Pooting ❑ Mctcr Basc ❑ Forestr�� �.
' P.R.I.F�.
� ❑ Underslab �Pinal ❑ Site
TOTAL �OVS.SO
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