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City of Carmel/Clay Township Permit #()t, () / 0057
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, &. Two Family: New Structures, Additions, Remodels, &. Accessory Structures
BUILDER of
RECORD:
PHONE
~ ~c 3/7~
FAX
/7-&.'3 - 3kJ
BUILDER'S EMAlL ADDRESS
PROPERTY
OWNER:
PHONE
FAX
-3/02-
LOCATION
&. PROJECT
INFO:
LOT # SUBDIVISION NAME
SECTION
ZIP
.J:;..; '//,03 'L
ZONINGS _ J
ADDRqJl~
SQUARE
FOOTAGE:
SEWER UTILITY
PROVIDER: 5, i-r' Co
NAME OF UTILITY EXCAVATION CONTRACTOR; PLAN COMIr1ISSION / BZA / BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY ~~ EPTlC PERMIT #'S (IF APPUCABLE):
<'<'_
TYPE OF ONSTR .~ ~ ~J ~il! \
o SIN I@:y C;; """
o TOW 'l.r;:;.r;:;.'Q 0
o TWO ,'I. 0
# of
o MULTI- ~\-1
# of U ~~: DETACHED GARAGE
o RESIDEN AL (For Q...f.U8.c;.ti~ GARAGE
Additions, em '. SED ~fi>oocm0N1UCTION
PROJECT INFORMAn6W~Ject to 5ompl;iInce with ail regulations
EarlY.Release DEP.T OOf~~f~~~lall"C('O:~SR"\IIf".ES
Permit: ---.:J." ~ T~'liliSe~iV'l), ~ ,) y. v 'N
L tS n' Vrrr 1(F CfuRM~,~J ~l...rW TFvV~HIP 0 CRAWLSPACE
o pi, _ _ um~~t':ll~~jA - - 0 SLAB
Does any part of the property lie within a special Flood designation area: _Y_N
PLUMBING CONTRACTOR:
Plumber's Indiana State License #:
Which plumbing codes will be applied to the construction:
'.
o International Residential Code w/Indiana Amendments
o Unifonn Plumbing Code wI Indiana Amendments
(Multi-Family Construction COde)
FOUNDATION TYPE: (Check all that apply for the new
construction area)
o POST & BEAM
o BASEMENT
WALKOlJT:_Y_N
For Single Family and Two Family dwellings. additions, remodels, and/or accessory structures, this permit is valid only if construction commences
within 180 days of the date of issuance of the building permit, and must be completed (Certificate of Occupancy issued) within 18 months of the
issuance date. Class I structure permits are subject to the General Administrative Rules of the State of Indiana (See 675 lAC 12) regarding expiration
time frames for beginning and completing construction,
I, the undersigned, agree that any construction, reconstruction, enlargement, relocation, or alteration of a sttucture, or any change in the use of land or
structures requested by this application will comply with, and conform [0, all applicable laws of the State of Indiana, and the "Zoning Ordinance of Carmel
Indiana - 93" (Z~ 289) and am dments, adopted under authority of I.c. 36-7 et seq, General Assembly of the State of Indiana, and all Acts amendatory
thereto. fu certify that 0 kitchen, bath, and floor drains are connected to the sanitary sewer. I further certify that the construction will not be
used or until a Ci . cate of Occupancy has been issued by the Department of ommunity Services, Carmel, Indiana.
Upper Footing Lower Footing Un
Rough In Meter Base c9
,2.-,.o~
-.J-~-o~.
Date
Signatu of Owner or Authorized Agent
OFFICE USE ONLY: *************
P.R.I.F,;
Additional Fees
Reviewedl App
S:Petmlts/FormS/I