HomeMy WebLinkAbout 0086.00 ApplicationMl eZ'Gay D O Permit No. �o.a
,wnslup Application for Date
!'r � Improvement Location Permit Roll File
This permit is valid only; if construction is started within 120 days of issuance date, 41 constructionmust be competed (c/o issued) within 2 years of issuance,
date :unless 'an extension of time has been officisIly granted by letter by the Direelor, Department of Communi Services.
NAME PHONE
%/ear 9w� 5:/G- 97,7b
FAX
BUILDER
STREET // CITY
�G�Sa �ry%opy�) �6L
STALE ZIP
C. 1yCi7.r� /N Q6c32
TENANT NAME
(if applicable)
NAM PHONE FAX
��ti%Yr�t� �y�S 7
OWNER
OWNER
Yzcr7T
RELEASED -FOR CO' TRt�. !
e%e 2
/Ac.Rat�je�t_to c®m :�;� witF7ls� �r��^.:�;�: is
Lor sonornsiON
of 5?a/te� owi♦Ccrlk'
LOCATION
�a�rcrio
DEPT OF �iVCS;iikliCJO i $f c f x r .t
REDRESS OF CONMUCoON
qEL i.V/IAY T6j#Mt
A. TYPE OF CONSTRUCTION Do plans include a porch ? F.
1. ❑ Single Family ❑ Yes PNo
2. ❑ Two Family
3. ❑
Multi -Family
Type of Foundation:
4. ❑
Commercial / Industrial r
❑Crawlspace
5. M
Farm s;zren C She
❑Basement
6. ❑
OTHER
❑Slab
B. SEWER:
1. ❑ Public (Name of System 8—
2. ❑ Private (Septic Tank, etc.
C. WATER:
1. ❑ Public (Name of System )
TYPE OF IMPROVEMENT
1. New Struptuw�.
2. ❑ Addition 1ljiwkl 2�
3. 4SPfit
4.
5. 6.
7.
8.
G. Lot .
H. Flood Zones
1. Sump Pump
J. Manufactured Trusses
/a �<�G
I] 2o0o
YES
NO —"L
YES
` NO
YES
, NO
2. ❑ Private{Well )
D. ZONING: K. Plumbing Contractor �—
E. ESTIMATED COST OFLCONSTRUCTION
(Excluding Land Value) O Plumbing License # N4 ❑ BOCA or ❑ CABO
The undersigned agrees that any construction, reconstruction, enlargement, relocation ;or alteration of structure, or any change in the use of land
or structures requested by this application will comply with, and conform to, all applicable laws of the State of Indiana, and the "Zoning Ordinance
of Carmel Indiana - 1993" (Z-289) and amendments, • adopted under authority of I.C. 36=7 et seq,General Assembly of the State of Indiana, and all
Acts amendatory thereto. I further certify thatonly,U61ten,.bath, laundry, and floor'drains are connected to the sanitary sewer. I further certify
that the construction will not be:used or occupied until a Cerkfrcate of Occupancy has been issued by the'Department of Community
Services, Ca 1, Indiana
Inspections Needed:
If Ca" -- Footing/Underslab -Rough-tn Meter Base.
auarF of Owner or Muthoriked Agent
JA�he,,l / 4 SY�,✓ —?Qs7 Site Final C/O
(Print) G / C' (Phow Number) Permit (Square Footagej 0 .5-Do�
Sewer aci CaP tY Allotted /U� Sc'LN�/� Inspection Fees: 3�.w
Plan Commissio ZA Docket* Certificate,of Occupancy: / 5 '00
OTAL:
AtvD Reviewedleot'of Commtiuity Services Fee R eived By :: f mswp95gn m Ivy