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City of Carmel/Clay Township Je Permit #(Jf,O-:<.O.;2 /5
RESIDENTIAL IMPROVEMENT LOCATIO~1RMIT APPLICATION
For Single Family, Multi-Family, &. Two Family: New Structures, Additions, Remodels, &. Accessory Structures
BUILDER of NAME
RECORD:
PHONE
'-/6
ZIP
PROPERTY NAME
OWNER:
STREET ADDRESS
LOCATION
&. PROJECT
INFO:
LOU 2} (
SUBDIVISION NAME C'/
.tel
ADDRESS OF CONSTRUCTION
t. ole?
SEWER UTILITY c-'{;
PROVIDER: / It W ~
WATER UTILITY _
PROVIDER: ( 0', ^ I'f < I
..>~ dUd, .r.
"-::!::J:::o603:);;2J1
.
NAME OF UTILITY EXCAVATION CONTRAcroR; PLAN COMMISSION / BZA / BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'S (IF APPLICABLE):
TYPE OF CONSTRUCTION:
l3""'SINGLE FAMILY
o TOWN HOME
o TWO FAMILY
# of units:
o MULTI-FAMILY
# of Units:
o RESIDENTIAL (For
Additions, Remodels, Etc.)
TYPE OF IMPROVEMENT:
~STRUCTURE
o ROOM ADDmON(S)
o PORCH ADDmON(S)
o REMODEL
o ACCESSORY BUILDING
o DETACHED GARAGE
o ATTACHED GARAGE
o DEMOLmON
PLUMBING CONTRACTOR: '\: ~
h/; C-'C1~ o~,,~
Plumber's Indiana State License #: "+ .. ~
/ flY-yO '1 @. ~ ~~
Which plumbing codes will be applied to the constructio~,>
ntemational Residential Code w/Indiana Amendm~
Uniform Plumbing Code w/Indiana Amendments
(MUlti-Family Construction Code)
PROJECT INFORMATION:
M . ct red FOUNDATION TYPE: (Check all that apply for the new
Early Release , -' anu,a u , / _./co. nstruction area)
Permit: Y l./ N Trusses: '-'Y N ~e..r .
. v:. 7. 16JlS 0 ~WLSPACE 0 POST & BEAM
LotSpht: Y =N Sump Pump: v-Y _N ffSLAB B"'BASEMENT
Does any part of the property lie within a special Flood designation area: _Y ~ WALKOUT:_Y---N
For Single Family and Two Family dwellings. additions, remodels, and/or access . h 1\ ~9-i~>-i.s valid only if construction commences
within 180 days of the date of issuance of the building permit, and must be co ltbid(q::~~8at~?fOccuiGt~c~)I~I~ ,months of the
issuance date. Class I structure permits are subject to the General Administrative Rules ofc5~~~le!of'Jndiana.(~rR751~C1:2:j.~ding expiration
timeframesforbeginningandcoIf1~coris~:tinrt LOCal a I regUlations
I, the undersigned, agree that any construction, reconstruction, enlargement, relo9lRQE.~ iittG.tiox[br a;s.l;ructure, Qr l;;f~ge in the use of land or
s~ctures requested by this application will comply with, and c~nfonn to, all appll9able)fa@pf ~~.~l tft1:haiti,iah'<f ~~w~ance of Cannel
Indiana -1993" (Z-289) and amendments, adopted under authonty of LC. 36.7 et seq, General As'ir'6rltii'figille ~t{t!100~\U)a, and lJl~ amendatory
thereto. I further certify that only kitchen. bath, and floor drains are connected to the sanitary sewer. I f1f:t~~ ~e'r'Jrv1:i~.a~ ~ will not be
used or occu . ed until a Ci ifi, of Occupancy has been issued b~Department of Community ~~~&.rmel, Indiana.
? f// L (-. jl. u crS J -$ rP - d ,
ture of Owner or utho zed Agent PrMt Date
OFFICEUSEONLY:**********************************************j5~*********************
Filing Fees: 3, Lit)
INSPECTIONS REQUIRED: , -2 (' -7 --'0 # Ch ed R
~ ~ Base Inspections: , Ie r. ;) , arg 0-
pper Footin Lower Footin ' Under Slab ~ ,-, ReViews
Cert. of Occupancy: .::> j 5 u
/(){,lfYJ
1/ olL ;<.3, -)i
4stJ:
Final
e
P.R.I.F.:
Additional Fees
Reviewed/Approv . ept. of Community Services
S:Permfts/FormS/ILP RESIDEN'nAL