HomeMy WebLinkAbout05110041-Application
City ofCarmel/C/ay Township Permit #: fJJ//DCXfI
CO:MMERCIAL or INSTITUTIONAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Commercial or Institutional: New Structures, Additions, Remodels, Tenant Finishes, &. Accessory Buildings
FAX
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BUILDER of
RECORD:
NAME
PHONE
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FAX
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CITY
STATE
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BEST METHOD OF CONTACT:
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PROPERTY
OWNER:
PHONE
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LOCATION
8< PROJECT
INFO:
STREET ADORESS
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ADDRESS OF CONSTRUCT10N
3~
sum # (If Applicable)
CITY
STATE
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BUILDING, PROJECT, OR TENANT NAME:
Lot # and Subdivision (If Applicable)
LDIV{. R.'~fi6 W?>4-7'E-:5
TAX MAP PARCEL #:
STATE COMMERCIAL
OESIGN RELEASE #: 31 z r ':f-D
SCOPE(S) OF ~ FON W STR l<<' AROi 'iii! MEOi ~ PLUM
RELEASE: ~ ELEC 0 ~PKLR OtHER(S):
SQUARE
FOOTAGE:
I;LT-
ZIP
4 Z.'-f tJ
SEWER UTILITY ()
PROVIOER: C.- v tv CJ
ESTIMATEO COST OF CONSTRUCT10~ /
(EXCLUDING LANO VALUE) / ,,0, COO
.....
PLAN COMMISSION I BZA I BPW OOCKET NUMBERS; AND/OR ..I
COUNTY WELL AND/OR SEPTIC PERMIT #'S (If APplicabl;!,: ....,,'" r.nNSTFiUCTIO::
# of Floors: Elevator or LltR~~;~ \~~,I~?~~ ::,BLQG. c6~~~5fI~~lmE:' "i>1A5M' OCCUPANCY ClASSIFICATION:
TYPE OF CONSTRUCTION: - . o\TYpirOF IMPR:OVEMENT:RV\CEiiROJECT INFORMATION:
fiZ COMMEROAL DEPT OF~:J~~'~U~RErOWNS\lf~WYReleaSe V
(Privately owned hospitals -rv OF cEil1.MQDffiONc-,.1 Permit: _Y-L"li'l
and medical offices/centers C\ I 1 r" GI)I '\dom(~) V
'recommercial) Irl:) 'PorCh lot Split: _Y 7""'t-N Sump Pump: _~N
o INSTITUTIO M ONAL liP bl' Bid 0 Mezzanine or Deck Does any part of the property lie within a special Flood
U",ClpO U IC 9 0 REMODEL
o School 0 NEW TENANT FINISH designation area: _ Y _N
o Church 0 ACCESSORY BUILOING PLUMBING CONTRACTOR' /.-(:.
FOUNDATION TYPE: (Check all which 0 DETACHED GARAGE <' L J'~ ~/, '''''eIJl..}.c./:::S\~~'\:
apply for the newconslruction area) 0 ATTACHED GARAGE . .)Gnu ""', Ivo< I ."t. /,' ,}0\ \ '\
~ SLAB 0 CRAWL SPACE 0 CELL TOWER (New) Plumber's Indiana State License #: / /\ \ "~,/' '~\~\\\\
o POST & BEAM 0 BASEMENT 0 CELL TOWER CO.LOCATE c::;. ~/ , .' " ~/ .~ \ \\
(or POST & PIER) WALKOLrr:_Y_N 0 DEMOLITlON 0 1{)=>S3~.s:-/ '. ~ ,\\),
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Class I structure permits are subject to the General Administrative Rules of the State of Indiana (See 675 lAC 12) regard}ng e*pifation time fraJ)les or ./,/
beginning and completing construction. \, \ \ \ ~ \j'\ /
I. the undersigned, agree that any construction, reconstruction, enlargement, relocation, or alteration of a structure, or any change in\he ~s_e~fland~ structur$s~"'" /
requested by this application will comply with, and conform to, all applicable laws of the State of Indiana, and the "Zoning Ordinance 6( CarrneUndiana - 19~3" (Z~ /"
289) amendments, ado ted under authority of l.c. 36~7 et seq, General Assembly of the State o( Indiana, and all Acts amendatory the}eto: Yfin;ther.ceitify that oP}y
kitc n, ath, and floor dra us are connected to the sanitary sewer. I further certify that the construction will not be used or occupied\Ui:tii'a) Geftilicate of/
Oce 'Y or Substanti 0 rpJetion has been issued by the Department of Community Se1c,s, Cannel, Indiana. '\ ////""
~ f2 .-' ~9\JVI.( VOlt' c 'vc). J'f '05-
Signature of OWner or Authorized Agent Print
Manufactured \/
Trusses: ~y _N
r.--
~ ., OV. I4-D~
Reviewed/ pproved. Dept. of Community Services (Date)
S:PermIt5{ ILP COMMfROAl .
Oate
Additional Fees
/-3 O~(}f,/