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SWIMMING POOL / SPA CONSTRUCTION
For Commercial, Institutional, or Residential Projects
"o.A"" City of Carmel; Department of Community Services PERMIT #:
BUILDER of
NAME
I-t At c' a eatahD-,
PHONE: PHONE: FAX:
%C,� 7ffl UV-i
RECORD:
y
STREET ADDRESS:
CITY:STATE: ZIP: �,p
B,UFER'S EMAIL ADDRESS:
BEST METHOD OF CONTACT:
PROPERTY
NAME:
PHONE: FAX:
OWNER
Slp ma-s r-e,-
STREET ADDRESS:
CITY: STATE: ZIP:
INFO-
PROJECT
ADDRESS OF CONSTRUCTION:
f2/7/ A&2 wL Lvi,-�
L4•�,,c / t/� .
LOCATION
PROJECT NAME: (If applicable)
LOT # and SUBDMSION NAME: (If applicable)
INFO'
ESTIMATED COST
SQUARE FOOTAGE y� 2-
TYPE,
OF CONSTRUCTION:
60,o0c,
Including deck
area:
IF APPLICABLE:
SUMP PUMP: ❑
YES ;I- NO
POOL COLOR:
IS ANY PART OF PROPERTY WITHIN
(If YES —INDICATE DRAINAGE ON SITE PLAN)
i
SPECIAL FLOOD HAZARD AREA: ❑ YES ❑ NO
STATE COMMERCIAL
CLASS OF POOL
SCOPE(S) OF
DESIGN RELEASE #
IF COMMERCIAL:
RELEASE:
POOL COVER: ❑ YES ENO
IF APPLICABLE:
AUTO FILTER: Vr YES ❑ NO
SEPTIC SYSTEM: ❑ YES NO
POOL HEATED: J2—YES ❑ NO
IF HEATED: ❑
GAS Z ELECTRIC
SLIDE: ❑ YES O'NO
DIVING BOARD: ❑ YES 1' NO
POOL BUILDERS WILL BE RESPONSIBLE FOR: Notification to pool owners that these inspections are to be made, and also will relate the various codes
applicable. Pool builders shall coordinate with owners for the inspector's access to site on days inspections are scheduled. Under the Carmel / Clay Zoning
Ordinance, Chapter L9.0, Sec. ZY.06.US: -Late Pees shad be assessea on missea
wrrnour a %- i v .
This permit is valid only if construction commences within 180 days of the date of issuance of this permit and must be completed, having the
Certificate of Occupancy issued, within 18 months of the date of issuance. Class I Structure Permits are subject to the State of Indiana General
Administrative Rules (GAR 675 IAC 12) regarding expiration time frame�pV¢�j ning and completing construction.
I, the undersigned, agree that any construction, reconstruction, et �lo f�i �rj� f'' or any change in the use of land or structures
vliu requested by this application will comply with and conform to all al � M.a#t�nT ing Ordinance of Carmel Indiana —1993" (Z-289) and
amendments, adopted under authority of I.C. 36-7 et seq, General amendatory thereto. I further certify that only kitchen,
bath, and floor drains are connected to the sanitary sewer. I further certify that&�dQol�etot be used or occupied until a Certificate of Occupancy has been
issued by the Department of Community Services, Carmel, Indiana. suogPi(rr2@j 11E yl;M aoupildum of loafgnS
I also certify, under the penalties of Perjury (Indiana Code N 39I��'Z 1 thatJa oif t eQi3foti31> o�n I have provided in this Application and other
documentation is true and accurate to the best of my knowledge and belief, and that I have not knowingly or intentionally provided or omitted
any information that would tend to hide, obscure, or otherwise mislead the Dept. of Community Services regarding the truth of the matters
addressed.
goature of Owner or Authorized Agent Printed Name Date
OFFICE USE ONLY.***************************************************************************************�*******�**********
INSPECTIONS REQUIRED:
1s' BONDING / GROUNDING
2nd BONDING / GROUNDING
FINAL- Bldg FINAL- FORESTRY
FINAL — Carmel Fire Department
PERMIT FEE (Flat Rate + Sq. Ft. fee):
INSPECTION FEES:
CERTIFICATE OF OCCUPANCY:
TOTAL:
Ta"rn L�w Lf -3-- (K
lII(d Fee Receive by: Date
Reviewed/Approved: Dept. of Community Services (Date)