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City'ofCarmel/Clay Township Permit #: 06030 J&D
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, & Two Family: New Structures, Additions, Remodels, & Accessory Structures
NAMEex,
STREET ADDRESS
"2. \ 0'2 S. Aec)1
BUILDER'S EMAIL ADDRESS
e:,S~ \010
NAME
M"':::"E 1<\Xd."le~o
CITY
\JJ.:s.JOL\ .(b'\J\~ DIL Z-\OQS"IL\.~
BUILDER of
RECORD:
PROPERTY
OWNER:
ET ADDRESS
Oct 2.,
LOCATION
& PROJECT
INFO:
LOT #
P A\j \ U \.. 'J;J..\ l...
s.r.-
/JltJ L .C~..........
SUBDMSION NAME
ADDRESS OF <jONSTRUCI10N
\ \le2. TOllJue:
SEWER UTILITY WATER UTILITY
PROVIDER:CLA-I; '~~\.I> PROVIDER: vJeLL
NAME OF UTILITY EXCAVATION CONTRACTOR; PLAN COMMISSION / BZA / BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'S (IF APPUCABLE):
TYPE OF IMPROVEMENT:
o NEW STRUCTURE
o ROOM ADDmON(S)
o PORCH ADDmON(S)
o REMODEL
o ACCESSORY BUILDING
o DETACHED GARAGE
o ATTACHED GARAGE
"Y. DEMOlITION
PROJECT INFORMATION: ~
Early Release RELEASE~[,;Q'icf.r~.sTRUCTION FOUNDATION TYPE: (Check all that apply for the new
Permit: ~ubJe'Nto C'tr'usSesf.'J wi:" H!I ro,yulaUcNls construction area)
- - of Stet" an" Lt1cal (\'0':'" - 0 CRAWLSPACE 0 POST & BEAM
Lot Split: ~EFfbF e~~~:~~Y1~h~; ~.l}'J!'.~~S 0 SLAB 0 BASEMENT
Doesanypartoftl!Jl1"P~~r1J~~i,n~~~ijlIF,I~Il~!~~i tionarea: _Y _N WALKOUT:_Y_N
For Single Family and Two Family dwelliIi~!Mp.tp.pAs. remodels, andlor accessory structures, this permit 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 an onstruction, reconstruction, enlargement, relocation, or alteration of a structure, or any change in the use of land or
structures reques ed by this app ation will comply with, and conform to, all applicable laws of tbe State of Indiana, and the "Zoning Ordinance of Carmel
Indi J" ,289) and am dments, adopted under authority of I.C. 36-7 et seq, General Assembly of the State of Indiana, and all Acts amendatory
reto. I certify that 0 kitchen, batb, and floor drains are connected to the sanitary sewer. I further certify that the construction will not be
used or ed until a Ci lcate of Occupancy has been issued the D attment of Community Services, Carmel. Indiana.
~LI SP~ 5.-1..'3-Otp
OFFICE USE ONL ***** ***** * ** * **** *** *********** ******** ****}********** 9* * **** ****** ***
Filing Fees:_;( o:g . 75
INSPECTIONS REQUIRED: ,., '? ISO # Charged Re-
Base Inspections: 2 :;)
Upper Footing Lower Footing Under Slab Reviews
V Cert, of Occupancy:
Rough In Meter Base Final Site
P.R.I.F.: Additional Fees
~~ ~\~\.n.:IJ ~"At\.... ~O,~
Reviewed/ pproved: Oept. of Community Services (Date)
S:PermIts/FormS/ILP RESIDENTIAL
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Print
PHqNE
\o'S<6-Cf <S1..
FAA
(09lo-l30
CITY
..xu 0 R-.>
STATE
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ZIP
~l.oL2..
BEST METHOD OF CONTACT:
C:..el..L L,2-1-'2... '5"1
PHONE
.- '6bCl ~
FAA
L7~-~rzl.,lp
STATE
J:L{
ZIP
4 L.. D'l '1
SECI10N
ZONING:
~
SQUARE
FOOTAGE: lI.Ioos
ESTIMATED COST OF CONSTRUGTION:---..----.-- ._-.-
(EXCLUDING t.AN[iVA~l.IE)' (;;:~~l f;:~:~:i' I \'11'i~" i,:",:<\
i!] \i iL__, \.\.-../-' ;;.-~, ' ~~Ii ',~
, I
PLUMBING CONT
'U
I
Plumber's India a State License #:
Which plumbing codes will be applied to the construction:
o International Residential Code w/Indiana Amendments
o Unifonn Plumbing Code w/Indiana Amendments
(Multi-Family Construction Code)
Date
,
Fee Received by:
'6;<,