HomeMy WebLinkAbout06030084 Application
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City of Carmell Clay Township Permit #: 6& 0 30I:Y?'f
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, & Two Family: New Structures, Additions, Remodels, & Accessory Structures
BUILDER of
RECORD:
NAME /' ~ () ^-E .
-/1'....'-' L.
F /P-[ PEP,
STREET ADDRESS
L C.v,(...
BUILDER'S EMAIL ADDRESS
t1 c./<
S, .."re-
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PROPERTY
OWNER:
NAME
M:ke
f<v~' ;erg
STREET ADDRESS
7'1"1'1
~i,,;ele.
C, .1'1(<
LOCATION
& PROJECT
INFO:
LOT #
SUBDMSION NAME
ADDRESS OF CONSTRUCTION
J 110'-/
TOv-'1e
SEWER UTILITY
PROVIDER:
WATER UTILITY
PROVIDER:
PHONE
:,,-)/- U~tJ
FAX
.s 7/-2(,{:>
CITY STATE
Cc; r""e ( {./1/
BEST METHOD OF CONTAcr:
...1.-":'"..... """"",~,' I
ZIP
'i 6.?,) ~
PHONE
b 7CJ- gf,Cij-
FAX
CITY
J1"<, f~~-1
STATE
i-v" !'VDY IrJ
SECTION
.5 .'J /rl7 f...f1I)
ZIP
'Ib1l.,'"
ZONING:
ad
SQUARE
FOOTAGE: IS 2--0
ESTIMATED COST OF CONSTRUCTION: / /
(EXCLUDING LAND VALUE) ~1)
NAME OF UTILITY EXCAVATION CDNTRAcrOR; PLAN COMMISSION I BZA I BPW DOCKET
NUMBERS; TAC DATE(S); ANDIOR COUNTY WELL ANDIOR SEPTIC PERMIT #'S (IF APPUCABLE):
TYPE OF IMPROVEMENT:
o NEW STRUCTURE
o ROOM ADDmON(S)
o PORCH ADDmON(S)
o REMODEL
o ACCESSORY BUILDING Which plumbing codes will be applied to the ~.!!'"
o DETACHED GARAGE 0 International Resi . ~"N(ffJ.,-:~
i ~\ ~~~
R E ATTACHED GARAGE 0 Unj~ hlmDi~~'-
S jec~1fll CONSTAUC'](rt:i~ I "\~~6n Code)
o compliance with ali ,on. '''''in
~rM~J~'t03;lcJ LC:ai COdetotJ... ,
_Y _N ~~S:Ui- CCMM"JNI'/II{ '~ERc:'~~~
flY 1"",;:,- "'\..... . '-'. .L:.Y"t.~
Lot Split: Y N sumplp[;,,',p';-\i1JViEL)1' C~y TOWIf'S~
Does any part of the property lie within a speciaWhlka1ll&ignation area:
TYPE OF CONSTRUCTION:
~ SINGLE FAMILY
o TOWN HOME
o TWO FAMILY
# of units:
o MULTI-FAMILY
# of Units:
RESIDENTIAL (For
Additions, Remodels, Etc.)
i
PROJECT INFORMATION:
Early Release
Permit:
PLUMBING CONTRACTOR:
Plumber's Indiana State License #:
#
(t,,&,~If~at
o
Y
Y
N
N
For Single Family and Two Family dwellings, additions, remodels, andlor accessory structures, this pennit is valid only if construction commences
within 180 days of the date of issuance of the building permit, and must be completed (Certificate of Occupancy issued) within 18 months of the
issuance date. 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 -199r (Z'289) and amendments, adopted under authOrity of LC. 36,7 et seq, General Assembly of the State of Indiana, and all Acts amendatory
thereto. I further certify that only kitchC!l, bath, and floor drains are connected to the sanitary sewer. I further certify that the construction will not be
used or occupied until a C~6f Occupancy has been issued by the Department of Community Services, Carmel, Indiana.
~ .;'/'11.z/ f"'11f~J<.. G c..i/l.vGi.- 2- g-06
Signature of Owner or Authorized Agent Print Date
INSPECTIONS REQUIRED:
OFFICEUSEONLY:************************************************************************
Filing Fees:
(~ ~. #~~edRe-
t'P V ~
~~ .~\ Additional Fees
TOTAL:
~ ~GJvv-01L--Oa^, ~~
Fee Rece ed by ~
lc1wer Footing
.,~f
Base Inspections:
Cert. of Occupancy:
Upper Footing
Under Slab
Final (3
P.R.I.F.:
Rough In
Meter Base
Reviewed!Ap oved: Dept. of Community SelVices
S:PermltstForms,lILP RESIDE~L