HomeMy WebLinkAbout14050059 Application n.
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�,:� CITY OF CARMEL / CLAY TOWNSHIP PERMIT # /y�SOOs9
COMMERCIAL/INSTITUTIONAL IMPROVEMENT LOCAT[ON PERMIT APPLICATION
�Lp�Aµ� PorNew Struclirces,Add�tioiis,TenanC�Fmishcs,Reniodcls„and Acccssorv Structures
�BUILDER �NAME �,PHONEI FAX
oF � ic �•S 23q , ' ` ���
RECORD STREET ADDRE55 CITY' STATE ZIP
\1'Z\S �V�V�{-� � F
E-.MAIL.ADDRE55 . IBEST: ETHODbF
U r,. u�Pn -b�r Yt�a.n@ Chic , e. �
CONTACT
.� PLUMBING 'NAME �� �STATEOFINDIANA
CONTRACTOR 'LICENSE NOMBER
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PROPERTY NAME PHONE FA%
OWNER S�m6Yl ' '� -2 3— 03
STREET ADDRE55 CITY S7ATE 2IP
225 , �tJ 0.Sh�t, ' S�- ti��l�c�_11 Ils I ti 3�
PRO]ECT PROJECT OR TENANT MPIEX AND/OR BUlLDING NUMBER OF FLOORS ELEVATOR
LUCATION hl� 'L �Q7, c `t;' I� ❑ves �rvo
STREET ADDRESS,INCLUDING3UITENUMBER � C S7ATE ZIP
rfA"Ce �\�Q �O �Ar \� �}bb3
HAMILTON COUN PA CE ��NUMBER �ZONING FLOOD ZONE/5
LOTSPLIT �SEWERUTILITY WATERUTILCTY SEWER/WATER
o YES No c �'S}i11 �S4i n R L'EP45'�€#�R'`("(94�5TRUCrION
TYPE OF T�'PE oF eoNSrnucrxoN Numbe�or u��rs
PERMIT
�COMMERCIAL ❑�INSTITUTIONAL-❑MUnicipal/Public Buildi Of$ 8nd I.00B�CAGOS LTI-FAMILY I
EARLY REU15E 'TYPEOFiMPROVEMENT ' '
❑YES ❑NO �NEWSTRUCTURE �NEW�TENANTFIN6�I�FA$��1 �AY���BUILDNG ❑ CELLTOWER
❑ADDLIION-❑Room/s ❑Porch❑Deck ��REMODEL DETACHE DEMOLITION ❑ CO-LOCATE
PRO]ECT P�N COMMISSION/BZA/BVW DOCKET NUMBER/S AND/OR ESTIMATE SQUARE FOOTAGE
TAC DATE/S 1 � EXCLUDIN6 LAND �y�Y�i L�C� 3(�2
PDFBLANS 'TYPE OFFOUNDATION MANUFACTIIRED SUMPPUMP PORCH
CD ❑E-MAIL � SLAB ❑ BASEMENT-❑WALK-OUT TRUSSES
❑ CRAWLSPACE ❑ POST&BEAM ❑POSi&PIER ❑YES�. NO �YES �NO �YES�NO
STATE OF CDR NUMBER RELEA E DATE CONSTRURION TVPE OCCUPANCY CUISS
INDIANA 3 " G �\ k3
CDR SCOPE-0F. ELEASE ❑ HOOD TYPE OFRELEASE
' ❑FDN. ❑STR ARCH ELEf � MECH � ;5 R T �-a . �r.�
Classi structure pemiits aze subject to the State.of In a a���r�t'�Ir�N3tra .Rules (GAR 675 IAC l2� re�ardin�
ezpiration-time Franies fur b ginning and eompleting con truction.
1;ihe undersigneJ,agree that any cwistrimtion,recons�ruclion,�enlar�. ent,relocalion,oral[eration ofa s ructure,or any chan�+c im.lhe use ofland or
�struelures requeated by�hie appl citu n -ill c�m��lv aith and eanCorm y�� Pa��Plioable la��>uf�h�State ofI idiana und�he"'Lonmg Ordinancco(Carmel
Indiana—ii993°(G?89)andamendments,adoptcJunderaulhoritybfl.� - �eStateoCliidiana,and.Il�Actsamendatury
theretn �F' rther eertify[hat only ki�chen,balh,anJ iloirr drains are connecled to[he sanitary se�vur: i further certif��l6at lhe constnmtion will not br
used r oc �pied�nvtilalCeptif te�iFOceu��aney or ofSubs�an�ia6Con pl l nn has becn usued.bv lheDe��arimenf o(Commumty Sen�ices,Carmel,Indiana.
� � ���1 `��C��r�rs � b
Signaturebf0 e.orAUt orizedAgen[� VnntedXam� Oat�
...............................................................�......................., ........................... ..............................................................
REQLIIRED BASE INSPECTIONS * � PERMIT FEES p
� Filin / Rcvicw -1 3.z-,9,0 3 8 9 rq .-
*Additional ins�ections may be rec�uired. g ���"�R�Re,vie�
\,�( i Base Inspcctions Z38:+0'0 ,ss",� \a��y� i
[ ❑ Lo�ccrf-ootin�r �p Rou�h-In �Firc ��7iOJ�lO„Q'��l sc.} '9
. � : CcrC oYOccu��ancv �, 1;
: ❑ ll��cr Poutin� ❑ Metcr Base ❑ FoYestry � � '��� .,��y: �•
� P.Rd.F. '`�" � �y� �'S:
� ❑ Un Icrsla6 [� Final ❑ Sitc .1i . /� � �:
TOTAL �I�ZQeH�"`i•Il� +,?:� n,
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$I��' : . �d;` .�;4 �.� I_ J/:
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S.�Pd:nni�sVPOrmsVAppliaEons\RCSiJemiulULP Appliee�iunA201U-OJ ���I.'.is�Upda�eA 09/19/2010