HomeMy WebLinkAbout06030186 Application
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_';tyofCarmel/Clay Township Permit#: 0 ~n 30J~Co
COMMERCIAL or INSTITUTIONAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Commercial or Institutional: New Structures, Additions, Remodels, Tenant Finishes, & Accessory Buildings
BUILDER of
RECORD:
FAX
3/
.
PROPERTY
OWNER:
,
PHONE
"3
FAX
~W'- 6~/ /
ZIP
%2l?O
2-4/
'"
100
I
CITY
STATE
(k
LOCATION
& PROJECT
INFO:
lot # and Subdivision (If Applicable)
SCOPE(S) OF 0 FDN 0 SIR
RELEASE: ly' ELEC 0 SPKlR
TAX MAP PARCEL #:
~~~E: 3t.e70
WATER UTlUlY I SEWER UTlUlY
PROVIDER: ~ r M ~ PROVIDER:
PLAN COMMISSION / BZA / BPW DOCKET NUMBERS; AND/OR
COUNTY WELL AND/OR SEPTIC PERMIT #'S (If APP!Lc;a~:-\
-~.- ,
I Elevator OPt, 'trt-r:5J ['58.' N '
.....~ \ ";.,J ~,
-- /'~ \~-_:::... ,,'-----
F N N:\~
\, \8> -~
COMMERi [;;::0-- c. Early Release
(Pri~:,\~1 ~ed hospitals 1\ 1 '1SlCl'u Permit: _Y ~
and l\l I ffices(Ci1\~""
= II) \1\" Porch Lot Split: _Y _vtr Sump Pump: _Y "'"N
o INO ~d Pu g E~EA ,_, obFe~~~uclf'lt5~ypartofthepropertyliewithinaSpeciaJFIOOd
o S<.t'dol S c mrTENANTFlNiSHI!1 regu~tionarea: _Y vN
o Ch C!!J SiI€CeSSORY Bl'lIEDlNGdes PLUMBING CONTRACTOR:
OUND TIONTVP ckallwhich DEPT()F~CHEDIGIE' c'- '\/rhr:::",.. L - .. S: . -r-.., .
apPIYforthenewconstructionarea)CITYOlEr.'(\FAyq,iED~ E ':;!::R_v~ ~ec.\'i>l\l.~ f0tCE,S 4-I'\\c.
6 SLAB 0 CRAWL SPACE '(j-''CEl.~ 'rOWER .jY I OWN~s Indiana state License #:
o POST & BEAM 0 BASEMENT 0 CELL!W'<Y!;ll,m\LOCATE W I 0'
(or POST & PIER) WALKOUT:_Y_N 0 DEMOLITION ~OJt0t'l3 /)
rf./
E5T1MATED COST OF CO~jlRUCTION:
(EXCLUDING LAND VALU9f 0 7
.', O()
EJj-f
OCCUPANCY CLASSIFICATION:
# of Floors:
PROJECT INFORMATION:
Manufactured
Trusses:
_Y\.....-N
dass 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 Cannellndiana - 1993" (Z~
289) and amendments, adopted under authority of J.e. 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 0[ SUb..<t':'~:!:.n has .::n issu~ by the Department of Community Services, Cannel,Indiana. ~
~ :... r ~ ~h/€ (/6
Signature of Owner or Authorized Agent Pri t Date
OFFICEUSEONLY:************************************************************************
INSPECTIONS REQUIRED: Filing Fees: q 70, :5 tJ
. . ~?l # Charged Re.
Upper FootIng Lower FootIng Under Slab Base Inspections: /1 ;1 . 0 (/ Reviews
_~ __ c;) - c.rt.,,,,o=,,~. 60
. ~ Additional Fees
TOTAL . ~.
20Q(, .~.~ (j -
Fee Received by: