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***IMPORTANT NOTE: THE OFFICE OF BUILDING AND CODE ENFO~CEMENT {
RECOGNIZES ANY ROOM/AREA DESIGNATED ON CONSTRUCTION PLANS AS A "BONUS
ROOM" TO BE AN UNOCCUPIABLE, UNFINISHED SPACE. IF AN AREA SO LABELED
IS TO BE A FINISHED SPACE, CONSTRUCTION PLANS MUST BE LABELED ACCORDINGLY,
IF IT IS DETERMINED THA TAN. UNFiNISHED "BONUS,ROOM" AREA IS TO
BECOME A FINISHED AREA AFTER THE ISSUANCEOF THE PERMIT, THE PLANS
AND PERMIT RECORDS MUST BE UPDATED AT THE OFFICE OF BUILDING & CODE
ENFORCEMENT. ***
I CERTIFY THAT ALL OF THE ABOVE LISTED INFORMATION IS SHOWN COMPLETELY AND ACCURATELY ON THE
ATTACHED PLOT OR SITE PLAN AS SUBMmED WITH A BUILDING PERMIT APPLICATION TO THE CARMEL-CLAY
DEPARTMENT OF COMMUNITY SERVICES. I FURTHER CERTIFY THAT THE JOINING OF WATER SUPPLY PIPING
SHALL BE MADE WITH LEAD-FREE SOLDERS AND FLUXES. FAILURE TO COMPLY WILL RESULT IN A REPLACEMENT
OF THE SYSTEM. PLUMBING CODE P-S09-S.
Under the penalties af perjury (Indiana Code 35-44-2-1), I hereby affirm under oath that all of the
information I have provided in the table below is true and accurate to the best of my knowledge and
belief, and that I have not knowingly or intentionally provided or omitted ony informotion thot would tend
to hide, obscure or otherwise misleod the Dept.' of Community Services regarding the truth' of the
matters addressed therein.
BASEMENT 1st Floor 2na Floor 3'" Floor Front Rear Total Sq. TOTAL
(Finished and Porch Porch or Ft. of
Unfinished) Sunroom . ,
Garages
2..'1......:::)
Z Z-CO '7 7 r~ Z3/o 18 900 7b '2-8
I $F
NOTE: Additional plans and/or information may be required, if submitted plans are not of sufficient clarity or detail, to
indicate the nature and extent of the work proposed and to determine compliance with all applicable codes and
. ordinances.
In addition to the above, the Building Inspector will be provided with any information relative to commitments
made in the zoning process for the property involved. This would include any Plan Commission and/or BZA
activity .
APPUCANT'SIGNATURE'5~ -5~
ADDRESS: .5"lf JO I...h.:x:J f 'd.d U~ ~
PHO~E: 8'-1:5 - 7S't't .
IJJ VbUli'
Department of Community Services
One Civic Square, Carniel, IN 46032 (317) 571-2444.
s:Permlts/forms/Permlnfo Rev Jan'02 Rev. Jan. '02