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City of Carmel/Clay Township Permit #:(';;b(JL/{J~ SI
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, 8< Two Family: New Structures, Additions, Remodels, 8< Accessory Structures
BUILDER of
RECORD:
NAME /1
lAJ/l 'r,
PHONE
C OM 3',:p..lt6.45SiVC. ..i'/7- ()7-eiZ7
Its.
FAX
,j'/7 -,575' -~S-05
ZIP
z~
STREET ADDRESS
3'12S ,/4v€/Z- 6z..:;ss.
~
STATE
:z;.L
BUILDER'S EMAIL ADDRESS
(!.4Si&/(rnA-"''''/ . :S8CG(.aBAI-~i1G-t
BEST METHOD OF CONTACT:
PROPERTY
OWNER:
NAME
u)€AtiJy Cf'~et)
PHONE
S75'-5'5"crD
FAX
LOCATION
8< PROJECT
INFO:
STREET ADDRESS
Zz 1'1- Co rt3-
LOH i/ <I
&J
cm
.:::I;;zd(
iJ< okj
SECTION
STATE
J0
ZIP
ADDRESS OF CQNSTRUcnON
12192. n~L. LN O,4,vl,Bt- ::IN
SEWER umm~' "7O..:.,JS/':/J WATER UTILITY I/ldia"""144>f16
PROVIDER: re' PROVIDER: . ~-r~71-
~t>{)3'2-
ZONING:Sz.
/ /. -S-'
SQUARE ~
FOOTAGE: ~
SUBDIVISION NAME
Sf', I"'~ LAitZ 6--m-re;.f
ESTIMATED COST OF CONSTRUCTION:
(EXCLUDING LAND VALUE) /7, 000. () 0
TYPE
o
o
o
PLUMBING CONTRACTOR:
P.w{ [. $'""".1'111
Plumber's Indiana State License #:
C-P8to 1777 /
o
Which plumbing codes will be applied to the construction:
~ International Residential Code w/Indiana Amendments
o Uniform Plumbing Code w/Indiana Amendments
(Multi-Family Con~truction Code)
FOUNDATION TYPE: (Check all that apply for the new
construction area)
Lot Split:
o CRAWLSPACE
o SLAB
_yX N
o
.
POST & BEAM
BASEMENT
WALKOUT:_Y~N
For Single Family and J:y.:,q ~~)t' I ~s..-~, git1~iri\~. ~o~~, and/or ~cessory structures, this permit is valid oOiIY if co t~' n commences
within180daYSofta?~~ii~~Cit'ffi1~h-ebUi~~r~V\@J\Pb:omPleted(Certi9i at )f Hi ' '. onthsofthe
issuance date. Class I 9a'o:Vi~'ph:f1gt\~:;siib~t t~~1f\.q.rit~m\Pe Rules ~ - 'a e'" g expiration
o ~h~ es ~M\\~'it'n'd completing' ,,' .
I, the undersigned, agree t~, . ~~Q, K~~~t . ~nlargement, relo~ation, or alte tion of a struc~,u re, or any change. in the ~se of land or
structures requested by th l~~atN~ \\, 1\.'io..conform to, all appbcable laws of the State of Induma, and the ~Zonmg Ordinance of Carmel
Indiana -1993" (Z~289) ~ n~nts, adopte~ ,~hth~rity of LC. 36~7 et seq, General Assembly of the State of Indiana, and all Acts amendatory
thereto. I further certify Mat 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 has been issued by the Department of Community Services, Carmel, Indiana.
~ ~_ e c.,UZ J;oZ'KNlJl,.,Jd
Signature of Owner or Authorized Agent Print
t.f! 4/0c.
Date
OFFICE USE ONLY: ************************************************************************
Filing Fees: I J- 3 -)'0 '
INSPECTIONS REQUIRED: t /, / /10
Base Inspections: '( , v' # Charged Re-
ReViews
Cert. of Occupancy: ~:3- i 0
Upper Footing Lower Footing Under Slab
~Ugl1~ Meter Base0nal 3,
(' ~ ~~ 111~ <7'-1/-06
Reviewed/Appr ed: Dept of Community Services (Date)
S:Pefmits/FOfmsjILP RESIDENTIAL
P.R.I.F.:
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Fee Recelv d by: ., ' -rf
Additional Fees
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