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City of Carmel/Clay Township Jl. \~ Permit #:O~OJ OI:Zt,.
RESIDENTIAL IMPROVEMENT L6tATION PERMIT APPLICATION
For Single Family, Multi-Family, &. Two Family: New Structures, Additions, Remodels, l!r. Accessory Structures
BUILDER of
RECORD:
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1
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STREET ADDRESS
STATE
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BEST METHOD OF CONTACT:
ZIP
'I J78'
BUILDER'S EMAlL ADDRESS
,
PROPERTY
OWNER:
NAME
bREE
s
STREET ADDRESS
LOCATION
&. PROJECT
INFO:
Joo
CITY
I
STATE
ZIP
'II.,J ~
s-
SQUARE
FOOTAGE: 70
ZONING:
SECTION
T
SEWER UTILITY E5T1MATED COST OF CONSlilUCTION:
PROVIDER(I A To PROv;9ER'\ (EXCLUDING LAND VALUE) 11' '
NAME OF UTI EXCAVATION CONTRACTOR; PLAN'C6M '
NUMBERS; TAC DATE(S); AND/OR COUNTY /\,!E~~~D[~: , :# OfeJ 01 D I :2 +
TYPE aF CONSTRUCTION:..-;:~(J~>;>r~;E F 1\ PLUMBING CONTRACTOR:
rn'" SINGLE FAMIL~./e, ~~)/ ~ l&,y E. SM',nl
o TOWN HOM)'- -' '\2~ / '1... RO ADD Plumber's Indiana State License #:
o TWOFAMILY~\\\ ~ 0 CHA I /777
# of units: \ \';,\ ~"i?' REM L ---10
o MULTI-FAMILY \'::\ 0 SSORY BUILDING wh9'plumbing codes will be applied to the construction:
O R#ESOIf Units: L (F \~\' DETACHED GARAGE ~ In~e tio~e5identlal Code w/lndiana Amendments
DENTIA or '\ ~ ATTACHED GARAGE ~1''"' "1,\
Additions, Remodels,' tc.) 0 Qft><lO~""":D FUR CO~~J-'~nl o/IDl~\l,l1dling Code w/lndiana Amendments
K\;;.I.-l:J"'l:l'''' 1- -,8 with ~Ji\ilJ'amlly Construction Code)
PROJECT INFORMATION: . act to corn? 'G>.' 'v LOC?I Codes. .r-=_
E I R I v< M f ct SUdbl~l tate and . f~~ON-l1'PE: (Check all that apply for the new
ary. e ease anu a ure OMMU'I'c!: h5t{Uctiona"""'-'1\-'
Permit: _Y ~ Trusses:' 0"" ~~I'l-L I CIJ,'1 \ U"'~'
,j;. ~ R'Mt: LJ CRAWLSPACE 0 Aosr & BEAM
Lot Split: _Y N Sumppu~ .C~'\ND\A\~ SLAB / (g' BASEMENT /
Does any part of the property fie within a special Flood designation area: _ Y -LN WALKOUT:_ Y ~N
For Single Family lUld Two Family dwellings, additions, remodels, and/or accessory structures, this pennit 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 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.c. 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 funher certify that the construction will not be
us d or occupied up-til a Certificate of Occupancy~Ms been issued by the Department of Community Services, Carmel, Indiana.
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Print
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Pate
OFFICEUSEONLY:*****************************************************'~****************
Filing Fees: '/ /) R 3, ';ZJl.
SPECTlO IRED: / ry /.-7
, Base Inspections: _--< r" /. )'0 # Charged Re-
ab . ReVIews
Cert. of Occupancy: S /":i-t'
P.R.I.F.: /2 (./ (JO Additional Fees
, /! ~
/' '~/, .~OTAL"M// ~ c.:)!,! 3,'50
G.: 'hi?,?.f ) . r
/ I//lt]j , ,
Fee ReCelved--by:
V
Site
Reviewed/ proved: Dept. of Community Services
s:PermJts/Forms/ILP RESIDENTIAL
(Date)