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REVISION / PLAN AMENDMENT or ADDENDUM to STATE RELEASE
For Commercial, Institutional, Industrial, or Multi-Family Projects
City of Carmel,. Department of Community Services
Permit has been issued: 1 Yes
y.
l.~
05/1 f29~q
No.
If yes, PERMIT #:
BUILDER of
RECORD:
""
BUILDER'S EMAIL ADDRESS:
b.:5'" ~-I L-...
cm:
-r'rJpLs
STATE:
:L.tJ
ZIP:
1.J6 ;1-20
NAME:
.LdN :S
Dr.
rv'<:-4<S
PHONE:
S7<!-Sl/8<!r
FAX:
S7t/-S~$d-.
LOCATION
& PROJECT
INFO:
,-;f "I
h{(.r
n
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BEST METHOD OF CONTACT:l ,(
-~I
LOI f and S~DIVISION NAME: (If applicable)
J'I - ljl&
Ri.....f......
ADDRESS OF CONSTRUcnON: r7 I
Lj'lS'~ ~-J&I ~'....tr:-
NEW SQUARE FOOTAGE OR ~ NEW ESTIMATED COST
AREA AFFECTED BY REVIS~ ~ OF CONSTRUCTION:
r.
}?P
NEW FOUNDATION TYPE: 0 SLAB 0 CRAWL SPACE
o POST & BEAM 0 BASEMENT (Walkout Y N )
STATE COMMERCIAL
DESIGN RELEASE #: 3/lj,{ '/7
DATE OF AMENDED RELEASE:
J- / l? -CJ-6
NEW SCOPE(S) OF 0 FDN ~ STR rx ARCH )6 MECH ~ PLUM
RELEASE: )I ELEC 0 SPKLR OTHER{S):
# of Floo;;>"
Elevator/Lift: P YES >Y'NO
BLDG. CONSfRUcnON TYPE:
OCCUPANCY CLASSIFICATION:
DESCRIPTION OF AMENDMENT/REVISION, AND/OR STATE RELEASE ADDENDUM/UPDATE INFORMATION:
!- J (' If eJ\?-- 11tA.-vVlAJ I~
. ~I
~ . 14 // L~'P~L,
?-tPqC)O(!) (!) ? f')
~k j(e!efffi-<?/r/~J)s
II
camp iance with all r ~nl dnti,..,.
Class I structure permits are 1!tEp-p 6'~~R-a1~d~!riis~/aQve:R:illes of the State of Indiana (See 675 lAC 12) regarding expiration time frames for
. l;UMI\/jbe~i~i:Jivg,~_~Fr91l?Ief'1~constructio~. .
I. the unclersll!l1ed, agree th:C1JyYoQlro@AA~1..\C~p.,JtQ-l;trg.~ent te1br.tttion, or alteratIon of a structure, or any change III the use of land or
sU'Uctures requested by this application will comprr..\yITh~ ahti'-cliMorkNl>W1~W~ple laws of the State of Indiana, and the "Zoning Ordinance of Carmel
Indiana - 1993n (Zr 289) and amendments, adoptcdlUNciddA1tt!Aity of I.c. 36~7 et seq, General Assembly of the State of Indiana, and all Acts amendatory
thereto. I also certify that only kitchen, bath, and floor drains are connected to the sanitary sewer. I further certify, under the penalties of Perjury (Indiana
Code 35~44~ 2rl) that all of the information 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. I also agree that the construction will not be used
or occupied until a Certificate of Occupancy has been issued by the Department of Community Services, Cannel, Indiana.
Sign.a:~ut~edA1t ZL prinfr"cJ/~y AJ. ~,",,:+L
!-JC>-Ob
Date
OFFICE USE ONLY: ** *****************jf;****** **** ****************************************
NEW INSPECTIONS REQUIRED:/' 855'~ PLAN AMENDMENT/REVISION FEE: e.s.s:1 ~
IN l,u. 0 n. ,:) Ifl.,j
Upper Footing Lower Footing Under Slab / '\ ADDITIONAL SQUARE FOOTAGE: I#-'
~~/~ ]\JEW INSPECT10NS REQUIRED: ?~r fI'l- ().
Rough In Meter Base Final Siter-~If additional Inspections other than what already remain on 9 permit are require .) ,~
Revie ed/Approved: Dept. 01 Community Servic
S:Permi /forms/Plan Amend Commercial, Ind, Inst, MultJ