HomeMy WebLinkAbout14050106 Application ������
�-a-� CITY OF CARMEL / CLAY TOWNSHIP PERMIT # �,
RESIDENTIAL IMPROVEMENT LOCATION PERM[T APPLICATION Sewer / Water U �li �
�xomx� For New StrucCUres,Additions,Remodels,and Accessory Structures PermiY$�
BUILDER NAME PMONE FAX
oF Q �h ma.s 8�f-aG�3 8r�� ��S-�
RECORD �TREET ADDRESS � C)T1'� STATE � 72IP
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E-MAIL ADDRE55 BE ETHOD OF
��/,(� / CONTACT
ll�r'7{'Q3N{� N iE � i✓7 ��
PLUMBING NAME /' STATE OF INDIANA PLUMBING CODE
CONTRACTOR �Y� (�i'A LICENSE NUMBExc�� a � �P� �'�RC o uPc
PROPERTY "a"'E // PHONE FAX
OWNER � an fibmrs �J'/9'o?��3 g�9�7dS!
STREETADDRE55 CITY /S7�ATE ZIF
(00.5 /iori ,S � !1 !/G+ YLayo
PRO7ECT �OT NUM6ER SU IViSI N NAME SEC7ION
LOCATION a� .� •�. C,�Zrar � l/G �- s f /
STREE7 ADDRESS C TE Z2P
USO �G� aSt �a�S�r� � o?
TAX MAP PARCEL NUMBER ONINCG OOD IONE/S
� � 'OQ —�- Q • 000 / � P
LO7SPLI7 SEWERUTILITY WATER TILIfY SE ER/WATE
O YES � NO ��fQ UT IESEXCA T �� ��
TYPE OF TYPE OF CONSTRUCfION MAS7 PERMIT FLO LAN
PERMIT SINGLE fAMILY PNO FAMIL O HOME O S � NO
TYPE OFIMPROVEMENT EARLY RELEASE
� NE4V STRUCTURE � RE DEL 0 ATTACHED GARA O ACCESSORV BUILD NG
Q ADDITION-O Room/s O Po O D k 0 BAS ENT FINIS � DETACHED GA � DEMOLIT[ON p YES �NO
PRO]ECT P�N COMMISSION/BZA/BP OC T NUMBER ND ESTIMATED T SQUARE FOOTAGE
TAC DATE/5 OFCONS7 ION, [� �7
� EXCLUD U1ND ��7v OOU � / �
PDFPLANS TYPE OFFOUNDATIQ!!, MA ACTURED SUMPPU. P PORCH
� SLAB �fT BASEMENT-O UT T SE �'
❑ CD O E-MAIL /'�
O CRAWLSPACE 0 POST&BEAhI OST&PIER YES � NO YES 0 NO YES 0 NO .
STATE OF CDR NUMBER RELEASE DATE CONSTRUCTION 7YP UPANCY CU155
INDIANA
CDR SCOPE OF RELEASE PE OF RELEASE - I '
FOR70WNHOMES q FDN O STR o aacn o ELEC O MECH � PLUM 0 SPKLR O OTHER �k
i
For Single Family and Two Family Dwellings ihis permit is valid only if construcYion rnmmence ithin I80 ays of the date of issuance of this Pe �t and
must be mmpleted�fiaving the CertificaM ofOccupancy issued,within I B months ofthe dat issuance. CI ' Structure Permits are su6ject to he State
of Indiana General Administralive Rules(GAR 675 IAC 12)regarding expiration Fime fre or 6eginning a tug ' �
I,the undersigned,agrce that any mnsvuction�reconstruRion�enlargement�rebwtion�or alteretion oCa structure,or any e6an�.e in the use oCland or
structures rey�evled by this aPPlication will comPly wi[h and conform to all aPPlicable laws o(the State oflediana and the°'Loning drdinanee ofCarmel
Indiana-I993"(7.-289)and amendmente,adopted under authori[y oC 1.C.36-0 et seq�Gencral Assembly of thc Slate of Indiana�and all Acts amendatory
thereto. 1 further certify that only kitchen�bath�and floor drains are connecled m the saniGry sewer. 7 further certify that[he construction ill mt be
used�uy'cu ied until a �ficate of ctupancy has Acen issued by the DePa�nt o(Community Servy es,Carmel�Indiana.
( :� �� ( ihr�i. h K��(! � 'S �'f�`�
Sign�o Awner Aufhorizetl Agant Vn Name Date
:......................................................................................� ;..........................................................................................
REQUIRED BASE INSPECTIONS * '• '• PERMIT FEES
*Additional inspections may be required. i Filing/Review . Re-Review
E BaseIns�ections
: ❑ Lower Footing ❑ Rough-In ❑ Final
: Cert.of Occupancy Other
t ❑ UpPer Footing ❑ Meter Base ❑ Site
; P.R.I.F.
� ❑ Underslab
TOTAL
; Reviewed/Released-Departmento(Community5ervices Uare ; ; Feelieceived-DeparlmentofCommwitySenices Dace ,
�....................'..................... ................ ....r �..............................................................................................�
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