HomeMy WebLinkAbout06030069 Application
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City of Carmel/Clay Township \J' G. ~ permit#()(p030D0C(
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, & Two Family: New Structures, Additions, Remodels, & Accessory Structures
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FAX
BUILDER of NAME PH<2
RECORD:
BUILDER'S EMAIL ADDRESS e::,
PROPERTY NAME
OWNER:
STREET ADDRESS
STATE
ZIP
LOCATION
& PROJECT
INFO:
LOT #
SECTION
ZONING:
.,
SEWER UTILITY
PROVIDER:
ADDRESS OF CONSTRUCTION ;;2. L2
WATER UTILITY
Q... ,\t,u)D PROVIDER:
NAME OF UTILITY EXCAVATION CONTRACT LAN COMMISSION I BZA I BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COU~. D/OR SEPTIC PERMIT #'S (IF APPLICABLE):
SQUARE
FOOTAGE:
Manufactured \ -' FOUND~TION TYPE: (Check all that apply for the new
Y Trusses: Z- Y N construction area)
- - ~ - 0 CRAWLSPACE _0 POST & BEAM
Lot Split: _Y N Sump Pump: Y N ~R\JGIOKBASEMENT
Does any part of the property lie within a special ,,~~~Jl~i" . :1iTeH-~ons WALKOUT:_ Y N
For Single Family and Two Family dwellings, additions, remade s, a~c@.~~~GfikQ~Jbermit is yalid only if construction commences
within 180 days of the date of issuance of the building pe~~~~~~~. i~~~CY issued) within 18 months of the
issuance date. Class I structure permits are subject to the ~~Raf~lirhiHistH~b~:iiul~ 1::~'i'~\JINStffP: 675 lAC 11) regarding expiration
timeframes~~~g@{4~Pikdl ... iMIclilll\.-'
I, the undersigned, agree that any construction, reconstruction, ~~gement, relo~a~on of a structure, or any change in the use of land or
structures requested by this application will comply with, and conform to, all applicat'~s 'Mt'h~ State of Indiana, and the "Zoning Ordinance of Cannel
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 y kitchen, bath, and floor drains are connected to the sanitary sewer. I further certify that the construction will not be
used occupieduntilaG .. t of. ccn CYhasbeeniSSUedbYt~()ntofCO~i~Cannel.lndiana. ~-C0
Sign Print ~ Date
Early Release
Permit:
LV: *********************************************8'*** **********************
Filing Fees: S-? [J 0
PECTlONS RE UIRED:
Base Inspections: ~ f, 7.. :)0 # Charged Re-
ReViews
Cert. of Occupancy: S I :) 0
/.2 6 ( 60
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Site
P.R.I.F.:
Additional Fees
Reviewed/Approved: Dept. of Ccmmunity Services (Date)
S:Permits/FormsjIlP RESIDENTIAL