HomeMy WebLinkAbout06020041-Application
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City of Carmel/Clay Township
COMMERCIAL or INSTITUTIONAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Commercial or Institutional: New Structures, Additions, Remodels, Tenant Finishes, & Accessory Buildings
(If!t?i?:OOj//
BUILDER of NAME PHONE FAX
RECORD: ~~.\ s rJcA,;"", tI\' . '51~' I'S~~ 57'f'65~
STllEET AODRESS CITY STATE ZIP
51$"'O (.,5+~ .,,+, J. Is. :D-.l 'ic..~:lO
BUILDER'S EMAlL ADDRESS BEST METHOD OF CONTACT:
W\4('O I +u1'1'. 0<<\ E-",,~;I
PROPERTY NAME 13\.t.i+Or-tl -Pf'''PU-I-i es LL(PHONE FAX
OWNER: Dr, n '?,.A'o,~ B (,,- t.oo 64(.,-SS7
STllEET ADDRESS . ii;50 CITY r0- [5 STATE ZIP
:Ir-J q 1e2'ltJ
SUITE # (If Applicable)
LOCATION
&: PROJECT
INFO:
u, IV'l"l; S+.
Address of Shell B Ildlng (If different than Address of Construction)
A.
TAX MAP PARCEl#: &-1-' -I -0;;'-01
-010.
- 00<1. 000
>j
BUILDING, PROJECT, OR TENANT NAME:
br. l... nn ~vv fOld"
STATE COMMEROAL
DESIGN REUEASE #: 31 3SBC.
WATER lJTILlTY
PROVIDER:
ZONING:
OJ'f,.....
- ~ "'0:1.5. ODD
III STR t:S. ARCH IlII. MECH \Ill PLUM SQUARE
o SPKLR ,OTHER(S): , . FOOTAGE: (",780
,.--._\ Ie If"""'" !~--" II "'i ,'~_:l I' ".1
1 ! r~, \ ,c \~~TI:D GOST,OF.CONSTRUqION:
Iii "',(e<ctUOlNGTANOVAWe! \\1 $l/J.ooo. 00
1 II!
Ii ili
OCCUPANCY~SIFICATION: B
-OIZ.
SCOPE(S) OF Jill FDN
RELEASE: Il( ELEC
Iwc..o
SEWER lJTILlTY
PROVIDER: c.. 'i< '-' D
PLAN COMMISSION / BZA / BPW DOCKET NUMBERS; AND/OR
COUNTY WELL AND/OR SEPTIC PERMIT #'S (If Applicable): Z"n.n . OSOl
# of Floors:..1 Elevator or Uft: 0 YES Pl NO BLDG. CONSTRUcnON
TYPE O~S'lay9lQ!\lOR CONSTR IMP OVEMENT:
l>'t ~ complianco with ai' r;g f STRUCTIJRE
(Prillate~hgsRIfi"j I ,." '",,, IIilB!lmoN
O=df11offices/ce. nters--o...,i;:!. I Codes. 0 Room(s)
r: 'Vr)' ....11'.
D IOa"'"i/i ,rUNITY SERVICEOJ Porch
~~D'.I.!;I_I "LAY 'r.olfrA' 'eJ Mezzanine or Deck
- " "D "Munld[iallPutlItC-BJ(j9-' ., UJI StIf~DEL
D School INDIANA D NEWTENANTFINISH
D Church D ACCESSORV BUILDING
FOUNDATION TYPE: (Check all which D DETACHED GARAGE
apply for the new construction area) D ATTACHED GARAGE
jli:( SLAB D CRAWL SPACE D / CELL TOWER (New)
o POST & BEAM 0 BASEMENT A CELL TOWER CO-LOCATE
(or POST & PIER) WALKOUT:_V....-N D DEMOLITION
PROJECT INFORMATION:
Early Release;( Manufactured
Permit: _V _N Trusses: Lv _N
Lot Split: _v.K..N Sump Pump: _V LN
Does any part of the property lie within a special Flood
designation area: _Y ~N
PLUMBING CONTRACTOR:
1lI~ lvrJy jJ\<<-\", " Ie, I
Plumber's Indiana state License #:
PLC.~ 0105"7'-1D
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 further certify that the construction will not be used or occupied until a Certificate of
Occupancy or S bstantial Ci 'PIe 'on has been issued by the Department of Conunw1ity Services, Cannel, Indiana.
, l,V"Jt. M. L..Qoc.k ;;l-"I-olD
Signa ure of Owner or Authorized Agent Print Date
OFFICEUSEONLY:************************************************************************
J ~ ~ '3 . 20
, ..57'7, SO
o ~.O 0
'3.
# Charged Re-
Reviews
I
Filing Fees:
Base Inspections:
Cert. of Occupan
.20010
Additional Fees