HomeMy WebLinkAbout06030090 Application
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City of Carmel/Clay Township Permit #: OCe0300,?O
COMMERCIAL or INSTITUTIONAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Commercial or Institutional: New Structures, Additions, Remodels, Tenant Finishes, &. Accessory Buildings
BUILDER of
RECORD:
NAME
PHONE
FJ>:X
653-
o
tV
rJCo
? "'J'v r-l
STATE
I/IJ
ZIP
'-16
8'0
STREET ADDRESS
00
BEST METHOD OF CONTACT:
dkQiVSCJ,J IrV<-,COpY! .2Sg -(, 67
BUILDER'S EMAIL-ADDRESS
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PROPERTY
OWNER:
NAME
PHONE
or1't
\
\ c:... VI I
STREET ADDRESS
I 00
cm
{'1er,'c{/q"" ea (' vY1 e (
STATE
IN
ZIP LfS6 S ~
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 Cannel Indiana - 1993" (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
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 Subs tial C on has been issued by the Department of Conununity Services, Cannel, Indiana.
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Print
LOCATION
&: PROJECT
INFO:
"
Address of Shell Building (If different than Address of Construction)
BUILDING, PROJECT, OR TENANT NAME:
Co. (\ cI; 0
STATE COMMEROAL
DESIGN RELEASE #: S I
WATER l1T1LITY ./.'
PROVIDER:
<," \
.....){J I
SCOPE(S) OF 0 FDN .. ~ c:VAACH
RELEASE: ~C ~I'KLR OTHER(S):
SEWER l1T1LITY /I"
PROVIDER: V
w
PlAN COMMISSION / BZA / BPW DCCl<ET NUMBERS; AND/OR
COUNTY WELL AND/OR SEPTIC PERMIT #'5 (If Applicable):
# of Roors:
Elevator or Lift: Qt1Es Q NO
BLDG. CONSTRUCTION TYPE:
TYPE OJ' OON~~N, TYPE OF IMPROVEMENT:
cYCOMMERI.QM.,. . ~~D rQR CON:t;:rF.N~~RE
(PrlvatelY'6#~~Jsplta,sm;)I',1r;( n W ['""101 ADD
andmedlcalofflcestcie@~e t"1';I'~ ;~,,-~/ '" ,r~43a ~S)
~re co 11'l'1!J't OF C ,d t.,. '" CO('€S 0 Pardi
o IN ONA~.. .OIViIH'"'Nirl'~SCi..,itmneorDeck
o n Rill1l'uJjJjC,~!9~,El / C! ..o.~PQ
o School ' h.'1 l '-NEW', 'Ui'FINISH
o Church INDIANA 0 ACCESSORY BUILDING
FOUNDATION TYPE: (Check all which 0 DETACHED GARAGE
apply for the new construction area) 0 ATTACHED GARAGE
o SLAB 0 CRAWL SPACE 0 CELL TOWER (New)
o POST & BEAM '!>if BASEMENT 0 CELL TOWER CO-LOCATE
(or POST & PIER) /\Il!ALKOUT:_Y_N 0 DEMOLlTlON
Signature of OWner or Authorized Agent
FJ>:X
sum # (If Applicable)
(.,:;--
Lot # and SubdMslon (If Applicable)
TJ>:X MAP PARCEL #:
CL-MECH
SQUARE
FOOTAGE: ;$ 2-6 d
PLUM
ESllMATED COST OF CONSTRUCTION:
(EXCLUDING LAND VALUE) I r:r 6 0 0 0
~
OCCUPANCY CLASSIFICATION: D
NFORMATION:
Early Release / Manufactured , /
Permit: Y ILN /' Trusses: Y Z
Lot Split: _Y ---'::1i Sump Pump: _Y_N
Does any part of the property lie within a special Flood
designation area: _Y_N
PLUMB~ CONTRACTOR:
! /'( ko ~-\
fVlecl
Plumber's Indiana State License #:
/0 & S3 /
1?,1ot-~?
Date .
OFFICEUSEONLY:************************************************************************
INSPECTIONS REQUIRED: e.- Filing Fees: ~ ~ ( , t) 0
. . Sll r I q ") 6-?'l # Charged Re-
Upper Footing Lower FootIng Under Slab 7, 0 Base Inspections: /> ' V Reviews
Meter Base & Site Cert. of Occupancy: 3 ' (') '0
'(p,.. .. ,. Addiuon.1 Fees
0'
(Date)