HomeMy WebLinkAbout14070060 Application �`��� f � � CITY OF CARMEL / CLAY TOWNSHIP PERMIT # ��%� �C�� t��'�J
�� RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION Sewer / Water Utility
� For New Structures,Additions Remodels,and Accesso Structures Permit�$
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BUILDER 9,
oF N!JEc�� ��s�M �� Lro 317-5 50813 3��. s�l _ s���
RECORD $TREEf ADORE55 CITY STATE ZIP
�,0 . Box 5s� ��S�t�es Iv �b�3�
E-MqIL ADORE55 r L BESf METHOD OF
�e�e5Cu5-�oM�ow.eS � SbC �ODct� .nPa CONTACT ��� • Xi i -3176
PLUMBING NAME (� STATEOFINDIANA PLUMBINGCODE
CONTRACTOR PL V M fj �C��I� LICENSE NUMBER O IRC � UPC
PROPERTY NAME PIfONE FAX
OWNER Kt� � S�� �RRM �� � DITIONAL
STREET ADDRE55 CITY SfATE ZIP
�3 85�1 �'w �� ��r-� C�« �. �il � _
PRO]ECT �O7NUMBER SUBDIVISIONN�E SERION
LOCATION �y 5 �g�51 pF �R+�Ml.Subject to compliance with all regulations
STREET ADDRE55 SfATE ZIP
�3�3g� iw �tit L�5 C�QCCG p�T Of COf�h�I��SERVICES ,J
7AX MAP PARCEL NUMBER LOOD ZONE/S
.�; • � . IND, A: � i,t,
LO7SPLIT SEWERUTILIfY WATERUTILITY SEWER/WA7 R
O YES I� NO C � q� UIILITIES FJ(CAVATOR
TYPEOF TrPEOFCONSfRUCfION MASTERPERMI7 FLOORPLAN
PERMIT NGLE FAMILY � TWO FAMILY � TOWNHOME O YES 0 NO
TYPE OFIMPROVEMENT EARLY RElEASE
q NEW STRUCTURE O REMODEL ❑ ATTACHED GARAGE q ACCESSORY Bu[LDMG
� ADDIi70N-O Room/s L7�or[h Cl Deck J$BASEMENT FM6H O DETACHED GARAGE � DEMOLITION O YES O NO
PRO]ECT P�N COMMISSION/BZA/BPW DOCKET NUMBER/S AND/OR ESTIMATED COST .y �� SQUARE FOOTAGE
TACDATE/5 OFCONSTRUCfION,.FI��� ��I�\� ��0�
EXCLUDING LAND V�� 0
PDF PLANS TYPE OF FOUNDATI6pl�, MANUFARURED SUMP PUMP PORCM
❑ CD O E-MAIL � SL48 /II�BASEMENT-O WALK-OUT TRUSSES
❑ CRAWLSPACE ❑ POST&BEAM ❑ POST&P[ER ❑ YES ❑ NO --Q NO
STATE OF �DR NUMBER RELEASE DATE CONSTRUCfION 7YPE OC S i
INDIANA
CDR SCOPE OP RELEASE TYp EL�E ��
FORTOWNHOMES O FDN o srn o ARCH 0 ELEC � MEqi � PLUM O SPKLR � OTHER
Por Single Family and Two Family Dwellings ehis Permit is valid only ifmnsVUCtion mmmences within 180 Aays of th ��r'+3�ce of titis Permifae�II
must be eompleted,having the Certifiwte of OccuPaney ieeued,within 18 months ofthe date oCiasuance. Claes[Structure PermiTS are subjeet to[he State
of Indiana General Administrative Rules(GAR 675 IAC 12)regarding exPire[ion timc Framec(or begiminP and mmple[ing consVUCtion.
1�the undusigned,agree that any construction,rewnstruction,enlargement,relocation,or alMration ofa structurq or any change in the use o(land or
struc[ures reyuested by thia aPPlication will comPly with and wnform to all aPPlim6le lawr,ofthe Stvte of Indiana and the°Zoning brdinance of Carmel
Indiana-1993"(Z-289)and amendmenta�adoprod under authority of I.C.36-0 et sey�Gmeral Assembly of the State of Indiana,and all Acte amendamry
therem. 1 further certify ihat only kitchen�bath,and�our drains are connected to the sanitary sewer. I further certif��tha[the construction will not hc
used or occuPie�d unt(i7l a Certilicatt of OccuPancy has becn issued by the DePartment olCompmu�nity Services,Grmel,Indiana.
�,P.�, e 1•�C.+'l'[n MP`� Q . �3.'� � Ifll �
Signahre o/Owner or Authorizetl Agent Printetl Name Dale
�......................................................................................4 ...............................................................................................�
REQLIIRED BASE INSPECTIONS * '• PERMIT FEES f
*Additional inspections may be required. i Filing / Review 1�.�,� Re-Review
i Base Inspections i�,� ,oe
� ❑ LowerFooting �Rough-In �Final 1_-� �v�
/" : Cert.of Occupancy �f1s��dL Other
: ❑ Upper Footing ❑ Meter Base ❑ Site
� P.R.LF.
� ❑ Underslab � • �b
�
TOTAL
���/�,r _. J _l`I— l�� o� ,
j iteviewed/Released Departrnent oCCommuNty Servicea Dare ; Fee Receive� —Depanmentof Communi[y Services ]ate ;
�......................................................................................i �..............................................................................................�
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