HomeMy WebLinkAbout14050203 Application `�y� � \
�°"`�"'� GITY OF CARMEL / CLAY TOWNSHIP PERMIT # /�/aSo2o3
� � . RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION Sewer / Water Utility
, �xoiex� For New Struclures,Additions,Remodels�and Accessory.Structures PCrmit#
BUILDER N ME PHONE FAX
oF ea��l C�..�iv�, l-4�-�� sq� - 53.� �
REGORD `+TREETADDRESS CI7Y STA7 IP
I � S. �2G.�. QM.e� � Cc�;� 1�� �CQ�.��.
E�-'/M�A^IL�ADD ESS /�y BEST METHOD OF
J"1CU��� M�/���. 'C � - CONTACT � �GI� p
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PLUMBING NAME SfATE OF INDIANA , / PLUMBING CODE
CONTRACTOR Pt LICENSE NUMBER CILJ lNl� D 4 !RC UPC
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PROPERTY .NAME . PHONE FA7(
OWNER ve Se�� n
STREETADDRE55 � , � ,. STpTE ZIP
� 3���-� �. ��iT.���'"�a� � mpllaneewithau�e��@�ly��,� (,�f �CP��
PROJECT �OTNUMBER SUBDIYISION B@fl SECTION
LOCATION � c�. C . NI'TY SERVICES
13��y 5�. �e�'���ti Nn �,��� �%� ��e�?�
TAX MAP PARCEL NUMBER ZONING FLOOD ZONE/S
I rl"0 1 -3U-�O -C�(L ' � � x
LOT SPIIT SEW ER U71LI7Y WATER U ll S R ATER •
O YES O NO Ca��i��l ��� � UTI EXCAVATOR��J��� L��C�,,�/%1 L. iC�
l.✓1, U�' �U
TYPE OF TYPE OF CONSTRUCTION A ERMIT FLOORPLAN
PERMIT �SINGLE FAMILY O TWO FAMILY � TOWNHOME O Y �NO
TYPE OFIMPROVEMENT EARLY RElEASE
� 0 NEW STRUCTURE B REMODEL D GARAGE q ACCESSORY BNLDING
�ADDITION-f.�ROOm/s q Porch q DeCk CHED GARAGE q DEMOLITION O YES O NO
PROJECT PLAN COMMISSiON/8ZA J BPW DOCKET NUMBER/5 AND/OR ESTIMATED COST SQUARE FOOTAGE
TAC DATE(5 OF CONSTRUCfION, ���� rl,'\/� n � �
� EXCLUDING��.LAND �y-��J � �
PDFPLANS TYPEOFFOUNDATION MANUFACfURED SUMPPUMP PORCH
❑ CD O E-MAII SLAB O BASEMENT�-O WALK-OUT 7RUSSES
�CRAWLSPACE O POST&BEAM 0 POST&PIER � YE$ �NO �YES � NO O YES �NO
STATE OF �Dli NUMBER RELEASE DATE CONSTRUCTION TYPE OCCUPANCY CLA55
INDIANA
CDR SCOPE OF RELEASE �TYVE OF RELEASE
FORTOWNMOMES ❑ FDN � STR O ARCH O ELEC � �MECH 0 PLUM ❑ SPKLA ❑ OTHER
For Single Pamily and Two Pamily Dwellings this�ermil is valid only if construc[ion commences rvithin IAO days of the dale of issuance uFthis Permit and
must be com�leted�ha��inp the Certificate oFOccnPancy issued�wil6in IA months oFthe date o(issuance. Class 1 Structure Permits are subject to[he Sla[e
of Indiana�Gencral Administracive'RWes(GAR G75 IAC 12)regardi�g expirxtion time Games for beginninp and comple�ing ronstruction.
I�the undersigned,agree that any construction,reconstruction�enUrgemenq relowtioq or.alteration ofa svucturq or any change in ffie use o(land or
itrifaures reyucsted by this aPPli`ation will com�ly with and conforn�to all appiicable laws ofthc StSte of Indiana and the`Loning brdinancc of Carmel
'Indiaua-I993'(Z289)�and amendmen[e�adoPted under aut6ority of I.G 36-0 et seq�General Assembly oCt6e State oE Indiana,e�d all Acls amendatory
thereto. 1 further certify that only'kitcFen�bath�and�oor drains arc connected to[he sanitary sewer. I further certi(y that the constrvetion will mt be
u' r owupied w 1il a Certificat oCOceupau has been iseucd by the Departmont oC,C mmuui[y Service rmel�Indiana.
.�,�n.(�i�.-v-�� � /
Signah ( wner n u ho'zed�Agent Vnnted ame pa
�......................................................................................• :.............................................................................................�
REQLIIRED BASE INSPECTIONS * '• PERMIT FEES
�� : Filing,/ Revicw 27g 3�
Additiunal insPections may be required. '/ Re-Revievv
i Baselns�ections �bZ-�o
i � Lower Footing � Rough-In Final. �
. � c. CerL of Occupancy 3. J Other
: � ilpper Foocing ❑ Meter Base �Site ��
� � P.R.I.F.
' ❑ Underslab TOTAL tS03 .�
€ 5-�- � ��tl� ' 7 — � (c-�� :
^.Re�dewed �Releave —ITeP3rtmentblCnmmuni[ySenices Date F Rce� el—UeP tmen o( ommunftyServfcu Da[e
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,enviulFOrmvWppiicaiionxVte.citlen�islllLP Applwaion@U09-OB lasv Updered 08t1320tN
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