HomeMy WebLinkAbout06030206 Application
City of Carmel/Clay Township Permit #:~
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:
NAME
L>"
STREET ADDRESS
O()() l.), OI4j:;.
;e., O.v::> ,\\
BUILDER'S EMAIL ADDRESS
e IZL T\.l~,JC:IR.,Go"-'\
NAME
'o+-'- D(. CA-iL"1E.L 0+, I,l..... ~
STREET ADDRESS
o~ C 1 ~ \c. S cP",""ILE
ADDRESS OF CONSTRUCTION
34~o LO.I~ S!
Address of Shell BuildIng (If different than Address of Construction)
~?:et.J
BUILDING, PROJECT, OR TENANT NAME:
C .+.,. ofC~\ V>A'
SEWER lITIUTY
PROVIDER: elI>,-t I I~'G.
n r- ,_, ~"I . V'lI
L...W l -- .
J~ '1~E~;,~PlP'~lCA with ail regulations
"', 'Il'Applicable):~" ,
~ C+~te. nrrll .')r.FiI Car!es.
# of Roors: 2.. ~"fI~ ~MJ~\p'qo~SiRu&i6N~:
~I}P,FCONSTRUcnONCI1YAt " '1" ^ vi! , '" 'l;:', I
ttf'"COMMERCIAL r I J ONEWlsmuCTURE
~(Prlvately owned hospitals ~/;. 0 ADDmON
and medical offices/centers ' Y. , 0 Room(s)
are commeraal) ~ ) ~O~ ~ Porch
I~ONAL I ~Mezzanine or Deck
~~niapal/Public Bldg ~ :', ~ 0 REMODEL
o School ~J.O NEWTENANTANISH
o Church foP" 0 ACCESSORY BUILDING
FOUNDATION TYPE: (Check all which -\ 0 DETACHED GARAGE
aP!'7 for ~~ ~ew 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 DEM0UT10N
STATE COMMEROAL
DESIGN RELEASE #:
WATER lITIUTY
PROVIDER:
It c.f6l!.A~".JS. -Fuc..\
SCOPE(S) OF llY1'oN ""'-STR
RELEASE: P"'ELEC ~SPKLR
i 5'36'1
Qass I structure pennits 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 Sute of Indiana, and the "Zoning Ordinance of Carmel Indiana -1993" (Z'
289) and amendments, adopted under authority of I.c. 3(5..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
Occupanc Subs aJ Completion has been issued by the Department of Conununity Services, Cannel, Indiana.
-M
Signature of Owner or Au
PHONE
3/7-'a7
CIlY
:::t:"oJ
FAX
'3/7-'073 -12.b<-.
STATE ZIP
BEST METHOD OF CONTACT:
PHONE
FAX
- 2,..IOD
STATE
ZIP
2.
"""4.N
~
SUITE # (If Applicable)
Lot # and SubdMsion (If Applicable)
ZONING: s- \
vAACH cYMECH
OTHER(S):
TAX MAP PARCEL #:
P'1lLUM
SQUARE
FOOTAGE:
ESTIMATED COST OF CONSTRUCTION:
(EXCLUDING LAND VALUE) 5 000, ex::/) "''.::..
OCCUPANCY CLASSIFICATION:
PROJECT INFORMATION:
Early Release I Manufacture~
Permit: Y N Trusses: Y N
Lot Split: Y j N Sump Pump: _Y _N
Does any part of the prope~ lie within a special Flood
designation area: _Y ~N
PLUMBING CONTRACTOR:
-rP /VIi:'C'"......II<:.t.+L /::;;.ff~7 ~Jler
Plumber's Indiana State License #:
C T Jr 76
7C /9160/2.0
ed Agent
"])"" "'rl 1..'7""-\;\..,,
Print
1>lA-\
3-2'1-06
Oate
OFFICEUSEONLY:************************************************************************
Filing Fees:
Base Inspections:
Cert. of Occupancy:
# Charged Re-
Reviews
Additional Fees
~ .~
Fe y~ 17, ,L,-;; "
proved: Dept. of Community Services
LP COMMERQAL
I./f7/0h