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City of Carmel/Clay Township Permit #:O?;O;;' () //&
COMMERCIAL or INSTITUTIONAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Commercial or Institutional: New Structures, Additions, Remodels, Tenant Finishes, &. Accessory Buildings
BUILDER of
RECORD:
PROPERTY
OWNER:
LOCATION
& PROJECT
INFO:
STATE COMMEROAL
DESIGN RElEASE #:
WATER lJT1LITY
PROVIDER:
NAME
G..p;+Oi (""'f+r"d;oN 5vcs J:N<-
STREET ADDRESS
q f30 B(;.~</ Dr/v<--
BUILDER'S EMAIL ADDRESS
C Wheeler e cap;-h,( co,"s*"0-, c~
NAME
Co[f.<r\ Tw-I~ M""'tr)'; T'<L~er
STREET ADDRESS
'O~I E, ~1"'< 5'j.f'<.cJ- >+r.. (00
ADDRESS OF CONSTRUCTION
1/ 5'5"0 N. f\'JBf'lcR'-c....v
Address of Shell Building (If different than Address of Construction)
SCOPE(S) OF.J#. 0 FDN 0 STR 0 ARCH
RELEASE: ,., ELEC 0 SPKLR OTHER(S):
SEWER lJT1LITY
PROVIDER:
PLAN COMMISSION / BZA / BPW DOCKET NUMBERS; AND/OR
COUNTY WELL AND/OR SEPTIC PERMIT #'S (If Applicable):
# of Floors:
,
Elevator or Uft: l:iJ YES Q NO
BLDG. CONSTRUCTION TYPE:
TYPE OF CON~E[I~I'lI:,__. " TYPE OF IMPROVEMENT:
J( COMME~ject f~":': I-OF! CO;\l<..QRN~_STRUCTURE
(Privately owned hb~Pltal5np!:~Jnt"'(.", j .....t::J 1~J1IJQJiV
and~icaloffiC"/c:ente, .,~, .,.. :". .',th a,l! r80!:i1t'R\lP,(Tl(S)
arecdm~OF- ~ ~,lu V)t'c-{ r' :d'LI' /9'61th
o IN~~~ Cr"", ". '., ~()dr:s,
O ..' ..r.-:.......~'--./I..L;J();\liTl" r:'):~r-" Q. Mezzanine or Deck
I r/"Upll~.,IjI,<jIt'L El"~L'
o School ~ / GL/\ Y 18l"lNEW:re~ FINISH
o Church INDIAN/\ 0""' AC~Soltf BUILDING
FOUNDATION TYPE: (Check all which 0 DETACHED GARAGE
apply for the new construction area) 0 ATTACHED 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 DEMOUllON
FAX
,'7'(- 'i'f?,2
CITY STATE
.:r;."l ''''"'''I''' {., :r:N
BEST METHOD OF CONTACT:
E,,,,,.,,.;I
ZIP
If O,po
PHONE
f'7o- ? 000
FAX
~'lo- {0I0
ZIP
L{
CITY
STATE
ZONING:
on
TAX MAP PARCEL #:
o MECH
o PLUM
SQUARE
FOOTAGE:
,H"J<t
ESTIMATED COST OF CONSTRUCTION:
(EXCLUDING LAND VALUE) 3f?,ooO
5bt
OCCUPANCY CLASSIFICATION:
PROJECT INFORMATION:
Early Release y Manufactured V
Permit: Y /''' N Trusses: _ Y ~N
Lot Split: Y f-N Sump Pump: _ Y XN
Does any part of the property lie within a special Flood
designation area: _Y_N
PLUMBING CONTRACTOR:
Ii
)L/ Ii(
,
Plumber's Indiana State License #:
dass 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 structure, or any change in the use of land or structures
requested by this application will comply with, and conform to, all applicable laws of the State of Indiana, and the "Zoning Ordinance of Carmel Indiana - 1993" (Z~
289) and 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 that only
kitchen, bath, and floor drains are connected to the sanitary sewer. I further certify that the construction will not be used or occupied until a Certificate of
Occupancy or S tantial C pletion has been issued by the Department of Community Services, Cannel, Indiana.
CI..a,./e) wke...f....-.
Print
F,.J, ;.:1,,0'
Date . .
Signa re of Owner or Authorized Agent
OFFICEUSEONLY:************************************************************************
g Filing Fees: 75" S. 1'/
?7\\ Ir;)..sl/
/0 '3.00
INSPECTIONS REQUIRED:
Upper Footing Lower Footing Under Slab
~Ug~~ Meter Base ~ Site
~'I\l\ \
. \lI'/\V IIlN\r't\o.J\() 1.&, a.<I:,a.oo~
Reviewedl"Pproved~ Dept. of Com'munily Services (Date)
s:Pem\\tsfForms/lLP COMMEROAl
# Charged Re-
Reviews
Fee Receiv
Additional Fees
0(3-:8 -tJ.,