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City of Carmel/Clay Township Permit #: cJLt 0;7.. ~.J~
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, &. Two Family: New Structures, Additions, Remodels, &. Accessory Structures
BUILDER of
RECORD:
NAME
PROPERTY
OWNER:
NAME
STREET ADDRESS
LOCATION
&. PROJECT
INFO:
LOT #
']
SEWER UTILITY
PROVIDER: C /( VJ f}
NAME OF UTILITY EXCAVATION CONTRACTOR; PLAN COMMISSION / BZA / BPW DOCKET
NUMBERS; TAC DATE(S); ANO/OR COUNTY WELL AND/OR SEPTIC PERMIT #'S (IF APPLICABLE):
TYPE OF CONSTRUCTION:
~iNGLE FAMILY
o TOWN HOME
o TWO FAMILY
# of units:
o MULTI-FAMILY
# of Units:
o RESIDENTIAL (For
Additions, Remodels, Etc.)
TYPE 0 IMPROVEMENT:
NEW STRUCTURE
o ROOM ADDmON(S)
o PORCH ADDmON(S)
o REMODEL
o ACCESSORY BUILDING
o DETACHED GARAGE
o ATTACHED GARAGE
o DEMOLmON
PHONE FAX
jY6-
$fATE ZIP
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BEST METHOD OF CONTACT:
(J
FAX
CITY $fATE ZIP
PROJECT INFORMATION:
Manufactured FOUNDATION TYPE: (Check an that apply for the new
Early Release /' "" ./ construction area)
Permit: _Y -7'~ Trusses: ~ _N ~WLSPACE 0
Lot Split: _Y --="l Sump Pump: _Y _N SLAB~-B-
Does any part of the propt!i'tliIie:~iMlVafi~~;r~(;6ti\Q a: _Y_N
POST & BEAM
BASEM ENT
WALKOUT:_Y ~
For Single Family and Two FaMh'y I ~elliiigs~4p tiorn' fepw~~' .~ accessory structures, this pennit is valid only if construction commences
within 180 days of the date of issuance ~tlie biilJai~g'ijer'ffiit.. @ ~-HSr rP}ll~d (Certificate of Occupancy issued) within 18 months of the
issuance date. Class I structure "3:ffilt~a~.G:08.ts't:[tlMt:ii d 0>_. trYt It.~ of the State of Indiana (See 675 lAC 12) regarding expiration
rlTV itF r.1'i'l!l'ffml1'l'Sfo&Jl!:\''I'nT@Wfl!@~construction"
I, the undersigned, agree that a1'r5' cbn:strbttion--;'rRbns'flu'cffonA ~ement, relocation, or alteration of a structure, or any change in the use of land or
structures requested by this application will comply \VidlN:Qj eoRikii\ll. 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 Act:S 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 ertmcate of Occupancy has been issued by the epartment of Community Services, Cannel, Indiana.
Z . L- C-f?rJ~ 2-6 -or
OFFICE USE ONLY: *********************************************~?~y~******************
Filing Fees: ?/L<;7"()
INS~ECTION~ REQUIRED: Base Inspections: ,.2(, "7 SCJ # Charged Re-
U6per Footi~ower i=oo~ Under Slab ~ ~ . Reviews
~ " ;.::> ) Cert. of Occupancy: '--" I J U
C....~C-,~, ~ P.W.. /ClC/-ji M':;""_
> /~_TO~~ /%,';23;/7/'0
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<fee'Recelved by:
Sign
of OWner or Authorized Agent
Print
( ~-l-ob
Reviewed/Appro ed: Dept. of Community Services (Date)
S:Permlts/FormS/ILP RESIDENTIAL
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