HomeMy WebLinkAbout14070074 Application �'��q�ei
i� CITY OF CARMEL / CLAY TOWNSHIP PERMIT # 1yo70o�`1
COMMGRCIAL/INSTITUTIONAL IMPROVGMEN'C LOCATION PGRMIT APPLICAl70N
�xm.x� For Nc���Struclures, Additions,'I�cnant Pinishcs;Remodcls,and Acccssorc Structures
BUILDER NAME , PHONE FAX
oF Ri� so� � l 3��- 31�-�y�,�5
RECORD STREET ADDRE55 , CIfY S7A7E ZIP
ts3b Fr ott�� w faR.�n a��0 �� �Il,��-l�3
E-MAII ADDRE55 BEST METHOD OF
; � A 1�c SCrl Com n1 e.�G�v � . Ca NL CONTAR .��-�, 3 i S' -7 � �(�
PLUMBING AME STpTEOFINDIANA
CONTRACTOR GX �Z�� LICENSE NUMBER '�� ` �(�a O Z
PROPERTY NAME PHONE FA%
OWNER H 1 ✓� �i?- �S6 -Z a0U
STREET ADORE55 CITY STATE ZIP
o � � ��h� ���w;q �-� �, �,.� ��� ��zaa
PRO]ECT PROJECT OR TENANT COMPLE%AND/OR BUI DING NUMBER OF FLOORS ELE�VATO
LOCATION 1�� E2 ,j � YES ❑ No
STREET ADDRE?�5,INCLUDING SUITE NUMBER �'�� CITY STATE ZIP 0
Z b 1 `'l f'Q n,.s �y Q K t a {�c �L c"' �"-�.'�-�I `��1 `Y lP Z O �
HAMILTON COUNTV PARCEL NUMBER ZONING� FLOOD ZONE/5
LOTSPLIT SEWERUTILTfY WATE0.UTILITY SEWER/W � �C
❑ YES ❑ NO UTILIRES O
'TYPEOF TrPEOFCONSTRUCfIO�bJgG�fOGORlp�l2lICCwIlfl2�IfCell�3�1005 ��� NumberafUnits
PERMIT �ERCIAL ❑ MSTITUTffiA8t81C�teLQllt��SPUbIi[Building ❑Sehool hureh ❑ MULTI-FAM LY
EARLY RELEASE TYPE OFIMPROVEM �^
°'" � YES ❑ NO � NEW STRURURF��7�/q�� /��g�,�C'IYI {�F�f�T��1(y{$�i ❑ AT-fACHE ARAGE ❑ACCESSORY BUILD � CELL TOWER
� ❑ADDITION-ORbrJmiyUlPtlr�RlLlllDFAC Of�ll'���Jf71I" ❑ DEfACH MM ❑ CO-LOCATE
PROJECT P�N COMMISSION /BZA/BPW D BER(5 AND/OR ESTIMATED COST SQUARE FOOTAGE
TAC DATE/S OF CONSTRUCTION,
EXCLUDING U1ND 9 7 a d o 3 3 Ql7
PDF PLANS TYPE OF FOUNDATION MANUFARURED SU P VUMP PO CH
O CD ❑ E-MAIL � SLAB ❑ BASEMENT-❑WALK-OUT TRUSSES
❑ CR4WLSPACE ❑ POST&BEAM ❑ POST&PIER ❑ YES O NO ❑ YES O NO ❑ YES ❑ NO
STATE OF CDR NUMBER RELEASE DATE CONSTRUCTION TYPE OCCUPANCY CLA55
INDIANA �]2 �CD -7 Q� �y l/-� SP(� � c�
CDR SCOPE OF RELEASE ,,_// ❑ HOOD TVP OF RELEASE
❑ FDN❑ STR O ARCH�C LI MECM PLUM ❑ SPKLR ❑ OTHER S�/ri..l DW'�Z�
Class 1 structure permits are subject to the State ol'Indiana General Adminisirative Rides(GAR G75 IAC 12) regardin�
c��>iretiun timc. frnmc+for bcbinnin�and com�ilctinb consiructiun.
I.�he.under>i�ned,agree Ihat am�conslructiun.rrcouslructiun,enlar�emenl.rclocalion.��ralleration ul'a ntrucWre,or anv chan�.e in�ho usr nllanJ or
strueLUres re��ue.e�ed ba ihi.n��plii7tiun will c�m�h'�vi�L nnJ cunform in all appli zLlc law.�ul'16c 1r.ilr ul'Indiann and Ihu"Zonin�Ordinance ofCanncl
Indiana-14i 1"(%-289)anJ amenJmcuu,adu�rted unJv.r aulhuritc ol'LC. ih-7 et eey.Genrral Assembl�'ul'Ihe Slate of InJiana,and all Ac1.amendaturv
Ihereto. I ILrlher eerliPo thal unlr kilchen.bat6.and Iluur drains are comiecled[o t6e ainitarv xwer. I further cer�i(v ihal the construcliun will nol 6e
uu�d c iivd until a CeI/licate o(Ucai�ianc��ur u(Sub.lanlial Cu�n�ile�i�n has been is{s�ueJ br U�e De�iartment ofC�mm�unih'Sen�iae..Grmcl.InJi�nn.
i�--� v{MV -/ t`�I�! ti. l' �� S ?'��" �`�
Signahre o wner or Authorixetl Agen[ prinled Name. Oate
:......................................................................................y ,..............................................................................................-.
REQUIRED BASE INSPECTIONS * '• PERMIT FEES
*Additional inspcction�ms�� bc rcc�uircJ. : filin� / Rcvic��� � ' '�� Rc-Revicw
[ Basc Ins��eclions 7i3 .��
t ❑ Loas'cr foolin�* � Rou�h-In ,� firc
� Ccrt. ofOccu��ancy �$.Ob pther
: ❑ U����cr Puotin� ❑ Mctcr 6asc ❑ I�orestr�� ��
' P.R.I.P.
� ❑ Undcrslab � I�inal o s��, �13'l6 •Su
� TOTAL
�
: $��,�,�7��5 ►a� ,�u -�—a 5--��
; ii � . � iiiii..: i o.�..�.... � i'�.........n�s. ...:................o��,• i-.�i�. �y,�„i�n� ��„ ���_ �
:... ,........ .......................... ................................................
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