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City of Carmel/Clay Township ...l!lP Permit #t:fo3tx2P!-
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, &. Two Family: New Structures, Additions, Remodels, &. Accessory Structures
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PHONE
BUILDER of NAME
RECORD:
,I( Ii
STREET ADDRESS '1'0 j S" p.
ZIP
'i6ZC((/
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PROPERTY
OWNER:
BUILDER'S EMAI>17RE~S
NAME
STREET ADDRESS
ZIP
LOCATION
&. PROJECT
INFO:
LOH ? J
SUBDMSION NAME
SEWER UTIUTY
PROVIDER:
ADDRESS OF CONSTRUCTION I"? 12
./ t7 OT
WATER UTIUTY ~.
PROVIDER: L (p ~ /"LC
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TYPE OF IMPROVEMENT:
G-1fEW STRUCTURE
o ROOM ADDmON(S)
o PORCH ADDmON(S)
o REMODEL
o ACCESSORY BUILDING
o DETACHED GARAGE
o ATTACHED GARAGE
o DEMOLmON
/,
70 dq</.<i'.)
. D6030~
(1"-1" "-
PLUMBING CONTRACTOR: ~
c.___ ( ?'/0 ~ q,. ~ ~
Plumber's Indiana State icense #: t'.f....2.. "
/Oryo1 @~~
Which plu.mbing codes will be applied to the construction: "'.1 ~
~mational Residential Code w/Indiana Amendme~
NAME OF UTIUTY EXCAVATION CONTRACTOR; PLAN COMMISSION / BZA / BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNn WELL AND/OR SEPTIC PERMIT #'S (IF APPUCABLE):
TYPE OF CONSTRUCTION:
P/SINGLE FAMILY
Li TOWN HOME
o TWO FAMILY
# of units:
o MULTI-FAMILY
# of Units:
o RESIDENTIAL (For
Additions, Remodels, Etc.)
2u fonn Plumbing Code w/Indiana Amendments
ulti-Family Construction Code)
PROJECT INFORMATION:
-..:_." FOUNDATION TYPE: (Check all that apply for the new
Early Release ../ Manufactured t-< . 1fW-'
Permit: Y N Trusses: Y N- construction area)
, t.../.: / - per- a;y(RAWLSPACE' 0 PQST & BEAM
Lot Spirt: Y _N Sump Pump: -...JLY _N p1~ tid.....Sf.AB ~ g...--!jASEMENT ~
Does any part of the property lie within a special Flood designation area: _ Y _N WALKOUT:_ Y_N
For Single Family and Two Family dwellings, additions, remodels, an~~6ryin:tic'tu;er;;this~ilif'valld:(f"rf(Y>>fonstruction commences
within 180 days of the date of issuance of the building permit, and musMie ,completeq (Cp:@c~~,e 9,f; 9F~P~~i~~~thin 18 months of the
issuance date. Class I structure permits are sub~ect to the General. Ad.ministrativec~u,~~'f~tt~~I~.?~~/c9p~m~~\r.ee ~51Ar: 12) regarding expiration
. . ume fram~s for begmmng.andc~o,~pl~~~g, ~~~~F~'J~q~Vi.....,,' {". ,.. ._) \ " .
I. the underSIgned, agree that any constructIOn, reconstruCOon, enlargement,relocaoon: or a1teraoon of-a: strilcture/or-anY\tbtiiS m the use of land or
strucrures requested by this application will comply with, and conform to@r~pp~pleajV,s'9f.r!1e' St<f~'o/ilI:1~f.,an4.~Rq ~ Ordinance of Carmel
Indiana - 199r (Z~ 289) and amendments, adopted under authority of I.e 36~ 7 et seq, Gener.;1 As,siw'QI,y of tl:le State drIMitah'i.lalt~all Acts amendatory
thereto. I further certify that only kitchen, bath, and floor drains are connected to the sanitary sel.V~A~ certify that the construction will not be
used or occupied until a G ci/ic e of Occupancy has been issued by t panment of Community Services, Carmel, Indiana.
U C C' J ~)g.-otf
Date
OFFICEUSEONLY:************************************************************************
Filing Fees: Pt630
INSPECTIONS REQUIRED: (/ '.-c
~ ~ Base Inspections: ::? c:, '7. J iJ # Charged Re-
per F ing ~ Under Slab Reviews
-. Cert. of Occupancy: c-I. ~ tJ
C::=-RoJl9JiIii'> M~e 'nal Site
P.R.I.F.: / c2 6/ ()O
~ () 5~h <'~' ~02lflt..
Reviewed/Appr ed: Oepl. of Community Services ate / ~;:,!!~ ,_ 1--0~_
S:PermIts/Forms/ILP RESIDENTIAL Fe~ReceiVed by: ,:./
Additional Fees
50