HomeMy WebLinkAbout06030139 Application
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City of Carmel/Clay Township Permit #: (J reflS Ol3Cf
COMMERCIAL or INSTITUTIONAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Commercial or Institutional: New Structures, Additions, Remodels, Tenant Finishes, & Accessory Buildings
BUILDER of
RECORD:
NAME
~ PHONE
. r:r;:z:p>' F" H M"l..el',.1 Cv.." T;2~(Jt>.e.50
STREff ADDRESS
FAX
~y~.- ,s;-S-V'- ,}/01>
~rk -- 5'5"i"- J '7,;2/
CITY
STATE
ZIP
'I'ir~<;z...
V-J"IRte.CJ-I /'VI'
BEST MEniOD OF COI'lTACT:
~&, - 'i(c';-- 0.;2'- .
o I\^()" r-l to> /QC.A i:>
BUILDER'S EMAlL ADDRESS
10 h; f' h. ,v\(.l..('4-; "', <:.0,,,,
FAX
B4/~' IS?\
STATE ZIP
tit It..{ H---r::, I L Lo
IN 4llL0'32-
PROPERTY
OWNER:
NAME
-pON
O\25lA-r--.l
PHONE
2--4'3 .-1'1 \ ? '10D
TENAI'lT NAME:
E.. ~'?O\ 71
SCOPE(S) OF M FDN p( STR .:l5t ARCH ;:>( MECH
RELEASE: :i2( Et!!C 0 SPKLR OTHER(S):
SEWER UTIUTY c..L.A\ "
PROVIDER: '\2ti--t1C>-JAt.. ~
STREET ADORESS
OD y<.\i':':::;\ l:)UNl)r=O;:= ~. .j::..
I
LOCATION
&. PROJE:'"t:
INFO: ~
PLAN COMMISSION / BZA / BPW DOCKET NUMBERS; ANO/OR
COUNn WELL AND/OR SEPTIC PERMIT #'S (If Applicable):
SQUARE
FOOTAGE:
\~ \07-
ESTIMATED COST OF CONSTRUCTION:
(EXCLUDING LAND VALUE) J ~ f>-
K' 1600
o
# of Aoors:
Elevator or Uft: 0 YES )I. NO
BLDG. CONSTRUCTION TYPE: 21?{ U M.-\[\
OCCUPANCY CLASSIFICATION:
TYPE OF CONSTRU@As' TYPE OF IMPROVEMENT:
ft( COMMEROALsu . ED F?R _C~;;N'"~lm.ilffiJhE
(PriVatelyown~~1~ COmpI':.nc.e \81 :ADDffiONltions
and medlcalofflces/centefsState ;::p(j 1,.',....,1 Co,g"::' Room(s)
_V'..t..! \..::>
arecommi....PT OF CO ,0 . pn_
o INSTITUl1 r= MM,jNITY ::I9RV~SorOe<:k
o Mu' ifaVFG>1ii: 6.fd1lRMEL / CD\YRJ;t@P!!!'JSHIP
o School I 8 NEW TENAr:ri' FlNISH
o Church NDI/.\NO ACCESSORY BUILDING
FOUNDATION TYPE: (Check all which 0 DETACHED GARAGE
apply for the new construction area) 0 ATTACHED GARAGE
:E1. 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 DEMOUTION
PROJECT INFORMATION:
Early Release V Manufactured X
Permit: _Y -C>,.N Trusses: _Y _N
lot Split: _y.2s..N Sump Pump: _Y )( N
Does any part of the property lie within a special Flood
designation area: _Y ^ N
PLUMBING CONTRACTOR:
~ F ,Te: LL-<'-.
,
Plumber's Indiana State license #: ~\
113\? -pc... '15 S7 0 ( t-j gu
c;P I tt Lf tJa
o,(~
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.
1, 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 confonn 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 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. 1 further certify that the construction will not be used or occupied until a Certificate of
Occupancy or Substantial Completion has been issued by the Department of Community Services, Carmel, Indiana.
( )W~- ~~ t/1t1)-.j~Oc//t-
Signature f OW r orized Agent Print
~s-/cs-
OFFICEUSEONLY:************************************************************************
NSPECTIONS REQUIRED: eJ Filing Fees: ');(0 c:zs 01, :3 8
. . ~1N ' ~ 77 ...-?\ # Charged Re-
Upper Footing lower Footing nder Slab ;1'" Base Inspections: --CJ ~ -....J U Reviews
ough In Cert. of Occupancy: :3 · (9 0
~: ' ~8" Additional Fees
z.4,;l.OO{, ~~
Reviewed/Ap roved: Dept. of Community Services
S:PermIts/Form LP COMMERaAL
Fee Received by: