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I CERTIFY THAT ALL OF �FHE ABOVE L�STED iNFORMATION TS SHOWN COMPLEfELY ANb ACCURATELY ON THE
ATfACHED PLOT OR SITE PLAN AS SUBMITTED WITH A BUILDING �ERMIT APPLICATION TO THE CARMEL-CiAY
DEPARTMENT OF COMMUNITY SERVICES. I FURTHER CERTIFY THAT 7HE JOI[�iNG OF WATER SUPPLY PIPING
SFiAL�. BE MAQ� WTTH LEAD-FREE SOLQERS AND FLUX�S. FAILURE �0 COMPLY WILL RESULT IN A REPLqCEMENT
OF THE SYSTEM. PL�MBING CODE P-509-5.
Under the penalties af perjury {Tndiana Code 3�-44-2-1}, T hereby affirm under oath that a11 of the
informntion T have provided in the tnble below is true and accurate to the best of my knowledge and
belief, nnd that I ha�e not knowingly or intentionally �rovided or omitted any inforrnation that would tend
to hide, obscure or otherwise mislead the Depfi. of Community 5ervices regarding the truth of �he
matters addressed therein.
BASEMENT 15t F[oor 2"d Floor 3rd FI00�' Front Rear Tota[ Sq. TOTAL
(Finished and PUrch POCCh or Ft. Of
Unfinished} Sunroom Garages
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NOT�: Addi�ional plans and/or information rriay be required, if subm�tted plans are not of sufficient clarity or detail, to
indicate the nature and e�ctent of the work proposed and to determine eompliance with al[ applicable codes an�
ordinances,
In addition to the above, tt�e Building Inspector will be provided with any inFormation relative to commitments
made in the zoning process for the property involved. This would include any Plan Commission and/or BZA
activiry.
APPLICANT'S SIGNATURE:
ADDR�SS:
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PHONE: � � �.� 1 � .� ��
Department of Community Ser�ices
One Civic Square, Carmel, IN 46032 (317} 571-2444
s:Permits�fozms/perminfo rev. March 2000