HomeMy WebLinkAbout 18010106 Application/r
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CITY OF CARMEL / CLAY TOWNSHIP
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For New Structures, Additions, Remodels, and Accessory Structures
PERMIT # 1150 ( U ((D O
Sewer / Water Utility
Permit #
BUILDER
NAME PHONE FAX
OF
RECORD
STREET ADDRESS CITY STATE ZIP
E-MAIL ADDRESS
BEST METHOD OF
L`��� C �15: t n �y • �<M
CONTACT
PLUMBING
NAME
STATE OF INDIANA
PLUMBING CODE
CONTRACTOR
LICENSE NUMBER
ElIRC ❑ UPC
PROPERTY
NAME II PHONE FAX
OWNER
�7D� i�rjN, (� m S Sri - 1-1' Li -in
STREET ADDRESS CITY STATE ZIP
" Off y, ° �z
1 ► J;E , V%M�
PROJECT
LOT NUMBER SUBDIVISION NAME SECTION
LOCATION
5 1� W I rJ pc►4,9,::r 3
STREET ADDRESS CITY STATE ZIP
I oy.�1 1�1G-N rE _ ice!^Cti yt� 41CO 2
TAX MAP PARCEL NUMBER
ZONING
FLOOD ZONE/S
LOT SPLIT
SEWER UTILITY WATER UTILITY
SE /WATER
❑ YES ❑ NO
ES EXCAVATOR
TYPE OF
TYPE OF CONSTRUCTION
ERFLOORPLAN
PERMIT
VMIT
y INGLE FAMILY ❑ TWO FAMILY NF$& Q
❑ NO
TYPE OF IMPROVEMENT V
EARLY RELEASE
❑ NEW STRUCTURE MO O ACH ARAGE 0 ACCESSORY BUILDING -
ADDITION - Y Room/s ❑Porch P.QDec BAS BOP1� GARAGE DEMOLITION
0 YES ❑ NO
PROJECT
PLAN COMMISSION / BZA / BPW DOCKET
MATED COST
SQUARE FOOTAGE
TAC DATE/S Q ' pit
CONSTRUCTION
EXCLUDING LAND�
PDF PLANS
TYPE OF FOUNDATION G
MANUFACTURED
SUMP PUMP
PORCH
Q CD ❑ E-MAIL
❑ SLAB ❑ BASEMENT - ❑ WALK-O P
TRUSSES
O CRAWLSPACE POST & BEAM ST & PIER
❑ YES NO
❑ YES ( _ NO
❑ YES NO
STATE OF
CDR NUMBER RELEAS� S
CONSTRUCTION TYPE
OCCUPANCY CLASS
INDIANA
§ \ago°
CDR
SCOPE OF RELEASE t( �a eS 2
TYPE OF RELEASE
FOR TOWNHOMES
❑ FDN ❑ STR Pik 0EC (��i Y] P �] SPKLR 0 OTHER
For Single Family and Two atII wel rmttCi$ d only if construction commences within 180 days of the date of issuance of this permit and
must be completed, having the CertiF ce dy t within 18 months of the date of issuance. Class I Structure Permits are subject to the State
of Indiana General AdministrativOot
arding expiration time frames for beginning and completing construction.
I, the undersigned, agree that a c n, rec�, enlargement, relocation, or alteration of a structure, or any change in the use of land or
structures requested by this appli ill comply with and conform to all applicable laws of the State of Indiana and the "Zoning ordinance of Carmel
Indiana — 1993" (Z-289) and ame nts, adopted under authority of I.C. 36-7 et seq, General Assembly of the State of Indiana, and all Acts amendatory
thereto. I furthe�f ertify that only kitchen, bath, and floor drains are connected to the sanitary sewer. I further certify that the construction will not be
used or occupied/f�nt a Certificate of Occupancy has been issued by the Department to/ofCommunity
AA Services, Carmel, Indiana.
//
Signature of n A Age Printed Name Da
�.....................................................................................� ............................
REQUIRED BASE INSPECTIONS * PERMIT FEES
* Additional inspections may be required. :Filing /Review
Base Inspections
❑ Lower Footing A2F Rough -In A Final
Cert. of Occupancy
Upper Footing ❑Meter Base ,,M Site
P.R.I.F.
❑ Underslab
Reviewed / Released — Department of Community Services Date
i.......................................................................................
S:\PennitstFongWpplications\Residentia� Application\2009-08
..................................................... .6
�p
' Re -Review
O
' Other
TOTAL
Fee Received — Department of Community rvices Date
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Last Updated 08/13/2009