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I CERTIFY THAT ALL OF THE ABOVE LISTED INFORMATION IS SHOWN COMPLETELY AND ACCURATELY ON THE
ATTACHED PLOT OR SITE PLAN AS SUBMITTED WITH A BUILDING PERMIT APPLICATION TO THE CARMEL-CLAY
DEPARTMENT OF COMMUNI i Y SERVICES. I FURTHER CERTIFY THAT THE JOINING OF WATER SUPPLY PIPING
SHALL BE MADE WITH LEAD-FREE SOLDERS AND FLUXES. FAILURE TO COMPLY WILL RESULT IN A REPLACEMENT
OF THE SYSTEM. PLUMBING CODE P-509-5.
Under the penalties of perjury (Indiana Code 35-44-2-1), I hereby affirm under oath that all of the
information I have provided in the table below 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 therein.
BASEMENT 1st Floor 2nd Floor 3rd Floor Front Rear Total Sq. TOTAL
(Finished and Porch Porch or Ft. of
Unfinished) Sunroom Garages
4/L/j 31/0
NOTE: Additional plans and/or information may be required, if submitted plans are not of sufficient clarity or detail, to
indicate the nature and extent of the work proposed and to determine compliance with all applicable codes and
ordinances.
In addition to the above, the 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
activity.
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APPLICANT'S SIGNATURE: C 0'`s�'--"`�'�'°i� /2"74.ta��r PHONE: 5"7`I- r7�
ADDRESS:
Department of Community Services
One Civic Square, Carmel, IN 46032 (317) 571-2444
s:forms/imprvloc/perminfo rev. March 2000