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City of Carmel/Clay Township Permit #Ct-iJ30IRLf
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family,&. Two Family: New Structures, Additions, Remodels,&' Accessory Structures
BUILDER of
RECORD:
NAME
BUILDER'S EMAIL ADDRESS
PROPERTY
OWNER:
NAME
~-
-
~
STREET ADDRESS
I~ 7/ W.
LOCATION
8< PROJECT
INFO:
LOT #
SUBDIVISION NAME
M
f?J,q
;:::
We-I/
NAME OF UTIUTY EXCAVATION CONTRACTOR; PLAN COMMISSION I BZA / BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'5 (IF APPLICABLE):
TYPE OF CONSTRUCTION:
o SINGLE FAMILY
o TOWN HOME
o TWO FAMILY
# of units:
MUL TI-FAMIL Y
# of Units:
RESIDENTIAL (For
Additions, Remodels, Etc.)
TYPE OF IMPROVEMENT:
;#. NEW STRUCTURE
o ROOM ADDITION(S)
o PORCH ADDITION(S)
o REMODEL
~/ '~ACCESSORY BUILDING
,/ 0 DETACHED GARAGE
o ATTACHED GARAGE
o DEMOLITION
o
~,
PHONE
FAX
780 -og7.:2.
5"}'(,-040:2..
ZIP
~ I. Ob 0
ZIP
q b 47
SECTION
ZONING:
."
ESTIMATED COST p~ CONSTRUCTION:
(EXCLUDING ,'ff"9 ~fLUE) I Q 0 ~ v
!I! I Ii '
it.lLoL___
,
PLUMBING CONTRACTOR:
- f\J11
I
Plumber's Indiana State License #:
Which plumbing codes will be applied to the construction:
o International Residential Code wI Indiana Amendments
o Uniform Plumbing Code wI Indiana Amendments
(Multi-Family Construction Code)
PROJECT INFORMATION:
j FOUNDATION TYPE:
Early Release j Manufactured
construction area)
Permit: Y . N Trusses: Y N
Lot Split: ""Fi C!4~;:lNr.:CH:~u(!!l~:~S1~~! jf;; I\J;.:N 6 ~:'::LSPACE
Does any part ofthe-prciperty-Iie witt\in a special flood designation area: _ y;r N
J:;.~.:h:.~.n1 ;.,., ,""..,.r'l;~,"''',f~:''.~-. '"Vt,,; ;,,1[ ;..o;}~lHH;:"li~,':.n~~
For Single Family 'and T~o~I]~Jy gw~llings::aadltioTrsfremodels, and/or accessory structures, this permit is valid only if construction commences
within 180 ~1'.:.<6the.date Of'is8.f1;taI}Cltffuh~bpild!\lEigl'IEwm'~'ian must be completed (Certificate of Occupancy issued) within 18 months of the
issuance date. .'etass I ~tMrurW~hllar~rS'ljHj~hfrlitie. . ~ mv.inistrative Rules of the State of Indiana (See 675 lAC 12) regarding expiration
CITY OF CARMEL I C!tii\1i(fr]; lu~g and completing cnnstruction.
I, the undersigned, agree that any cO~BN'lfonstruction, enlargement, relocation, or alteration of a structure, or any change in the use of land or
structures requested by this applicati~:hi~n'd~ffi'pry with, and conform to, all applicable laws of the State of Indiana, and the "Zoning Ordinance of Carmel
Indiana -I993~ (Z~ 289) and amendments, adopted under authority of r.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. I further certify that the construction will not be
used ~ til a Certificate of Occup e n issued b the D artment of Community Services. Carmel. Indiana. / I
f).M1 pr /I/' ~~g!..!!.:>..
Dale'
Site
~,::,'~"~~ ,,~-"--
Fee R ceNed by:
Signatu
OFFICE USE ONLY: ********
Upper Footing
Rough In
J'.
Reviewed/Approved: Dept. of Community Services
S:PermitsfForms/ILP RESIDENTIAL
(Check all that apply for the new
~ & BEAM
o BASEMENT
WALKOUT:_Y_N
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