HomeMy WebLinkAbout05110040-Application
City of Carmel/Clay Township Permit #: tJ5/IOo!i()
COMMERCIAL or INSTITUTIONAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Commercial or Institutional: New Structures, Additions, Remodels, Tenant Finishes, & Accessory Buildings
BUILDER of NAME \f, , Assoc. l t.jL PHONE
R.E <- 11. .n....., . ~S-S--=t-
RECORD:
STREET ADDRESS OTY STATE
I 3 Snuc CLe€l IU NolJLESlltlf€ f,.J
BUILDER'S EMAIL ADDRESS BEST METHOD OF CONTACT:
V 'l2.c;. 1-Q f"\I\S Y\. <....0 "'" L-
PROPERTY NAME ?J4TIIVV.fY'\ ?roP~ES PHONE
OWNER: 'if'1 00
STREET ADDRESS >>E-LG<O: 4-7t"S CITY STATE
1 0 IIVO l.S IN
GekAA><..c
Address of Shell Building (If~~a AclI of sr'~on4I;074
i321Hv ~
LOCATION
&. PROJECT
INFO:
BUILDING, PROJ'ECT, OR TEI'fNT NAME:
, PGf
STATE COMMEROAL C/
DESIGN RELEASE #: 3 I z. '1 rt 0
FAX
~It, 7t4, a-S-5"1
ZIP
'-1ft, O~ 0
+Z~-S)z..~
FAX
'8'/!J'-z... '1/0
ZIP
Y l..-'-!D
"'iyN:.}
SCOPE(S) OF \Zl FDN ~ STR ~ ARCH II<.. MECH 111. PLUM
REUEASE: I(' ELEC 0 SPKLR OTHER(S):
SQUARE
FOOTAGE:
WATER UTILITY
PROVIDER: ~ \'Y\.&L
SEWER UTILITY
PROVIDER: C. TR w.o
PLAN COMMISSION / BZA / BPW DOCKET NUMBERS; AND/OR
CQUN"TY WELL AND/OR SEPTIC PERMIT #'S (If Applicable):
# of Roors:
Elevator or Uft: c;I YES "! NO
BLDG. CONSTRUcnON TYPE: IYI A.5DLJ.
OCCUPANCY CLASSIFICATION:
\
dass I structure pennits are subject to the General Administrative Rules of the State of Indiana (See 675 lAC 12) regarding expirati6n tme fr~es for
beginning and completing construction. '..-..-/
I. the undersigned, agree that any construction, reconstruction, enlargement, relocation, or alteration of a structure, or any change in the use of land or structures __~
uested by this application will comply with, and conform to, all applicable laws of the State of Indiana, and the "Zoning Ordinance of Cannel lridiana - 199r (Z' ~__" --'
2 d amendments, adopted under authority of I.e. 36'7 et seq, General Assembly of the State of Indiana, and all Acts amendatory thereto. I further certifY..,!:l1at only
ki hen, th, and fl r ins are connected to the sanitary sewer. I further certify that the construction will not be used or occupied until a Certilica.te of
Completion has been issued by the Department of Commwtity Services, Cannel, Indiana. _.' f
-u~1J lS \J Or~
OFFICEUSEONLY:************************************************************************
'70$,1-/1
tftll. ?V~
119:3.(JO
''J, fa
TYPE OF CONSTRUCTION: TYPE OF IMPROVEMENT:
~ COMMERCIAL tlir NEW STRUCIURE
(Privately owned hospitals - 0 ADOmON
andmedicaloffi~-<l!!@ASED Fen CO~IEJ'C'Rdom(S)ON
are commercial). ,I '0 r \..... -....t, ' .
o INSTITUTIONAL SubjeCllo compiicJnce wilhd r'M~'T~,"t;,.,n~
~ ' ~ ezzanlne-or'Deck
o Municipal/Public Bldg State 2."':1 1[J.;2R510DEL
o School DEPT OF COri\'" Iill'I-NEW:rENANT~jgH
o Church,.ITV r\J:::" :~'."~d: Ai:CE5SOR~BUrtDlNG
FOUNDATION TYPE: tehe~klltlwlri{h9Mt:L Ic'3LoErAcHEO\GARAG'EP
apply for the new mnstruction area) IN 0 l/fillJ#lTACHED GARAGE
~ SLAB 0 CRAWL SPACE 0 CELL TOWER (New)
o POST & BEAM 0 BASEMENT 0 CELL TOWER CO-LOCATE
(or POST & PIER) WALKOUT:_Y_N 0 DEMOUTION
Signature of Owner or Authorized Agent
Print
ESTIMATED COST OF CONSTRucnON,.,j.
(EXCLUDING LAND VALUE) ~ I
~
0000
PROJECT INFORMATION:
Early Release 2 Manufactured
Permit: Y N Trusses: 2'5- Y _N
Lot Split: _Y N Sump Pump: _Y~N
Does any part of the property lie within a special Flood
designation area: _Y_N
PLUMBING CONTRACTOR:
.:=:) r h u I e<e- --;::>/ u rn is 1,v6-,
Plumber's Indiana State License #:- . -
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Date
Filing Fees:
Base Inspections:
Cert, of Occupancy:
~~eYieWed/A proved: Dept. of Community Services
~ :mltsfFo LP COMMERQAl
# Charged Re'
Reviews
:~
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Additional Fees