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City of Carmel/Clay Township )/f'.J.) Permit /tloo t.fV{)~$
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BUILDER of
RECORD:
FAX
676 ,;) 31
BEST METHOD OF CONTACT:
STREET ADDRESS
COY
-sf
PROPERTY
OWNER:
LOCATION
&. PROJECT
INFO:
SUBDIVISION NA~E
SEWER UTI
PROVIDER:
SQUARE
~,tJ ~ 0 FOOTAGE6'1
ESTIMATED COST OF CONSTRUcncarl
DING LAND VALUE) '7" / () 7/3
NAME OF LfTIUTY VA CONTRAO'OR; PLAN COMMISSION / BZA I BPW DOCKET
NUMBERS; TAC DATE(S); AN lOR COUNTY WELL AND/OR SEPTIC PERMIT #'5 (IF APPLICABLE):
~ I rYlCXJr-€
TYPE OF IMPROVEMENT:
Dr1'lE"w STRUCTURE
tr ROOM ADDITION(S)
o PORCH ADDITION(S)
o REMODEL
o ACCESSORY BUILDING
o DETACHED GARAG"
o ATTACHED GAP
o DEMOLITION
~BING CONTRACTOR: _
_ m I?J if ,~n::s __tr7c....
Plumber's Indiana State License #:
c-p 10000 /{5 /
TYPE OF CONSTRUCTION:
~INGLE FAMILY
tJ TOWN HOME
o TWO FAMILY
# of units:
o MULTI-FAMILY
# of Units:
o RESIDENTIAL (For
Additions, Remodels, Etc.)
Which plumbing codes will be applied to the construction:
~emational Residential Code w/Indiana Amendments
o Uniform Plumbing Code wI Indiana Amendments
(Multi-Family Construction Code)
M f ct d FOUNDATION TYPE: (Check all that apply for the new
_Y ~ Tr~~~~: ure kN construction area) filII
/,:'\ 0 CRAWLSPACE 0 POST & BEAMd:=J n /;:5;/ ed
Lot Split: _Y --& Sump Pump: Y _N 0 SLAB ~ BASEMENT ~
Does any part of the property lie within a special Flood designation area: _Y ~_.__~AL~~l!f~-~Y~
For Single Family and Two Family dwellings. additions, remodels, and/or accessory structures, thi~ pcr~ifis\JliiQ~olli~:if_b&~~ttk.!=~ibn ~om~~~c~
. within 180 days of the date of issua~ce of the ?uilding permit, and mus~ be c~mpleted (Certificate of O~~yob1!cy-issue(l) within 18 m~mths R~ dI'~l \
Issuance date. Class I structure permIts arc subject to the General AdmimstratIVe Rules of the State of Ind1a,;{<t'(s~e 675 lAC 12) regardmg eXp1raqop
time frames for beginning and completing construction. \ f\ \ \ ^ PR 1 2 20nh \; \ ! j)
I. the undersigned, agree that any construction, reconstruction, enlargement, relocation, or alteration of a strucmuk, dr'any dl~n'ge in die use 011and d~ L),' \
st~ctures req~ested by this application will comply with, and c~nform to, all applicable laws of the State of Ind~drla, h~p t~e ~Zoning ?:~2~~:,.::.~fgi-mel \
Indiana -1993 (2-289) and amendments, adopted under authority of l.c. 36~7 et scq, General Assembly of the State 01 Indlana;-and"all :A:cts amendatory \
thereto. I further certify that only kitchen, bath, and floor drains are connected to the sanitary sewer. I further dertify that the construction will not be ;
occupied until a Certificate of Occupancy has been issued by the Department of Community Servich...Canncl,-lndiana;----------------...-----
. (hnIC--P S+.eU/tY"J(:JU/c. "';'/ulo,c;.
~ Date
OFFICE USE ONLY: ************************************************************************
Filing Fees: c;' -,'~ 50
INSPECTIONS REQUIRED: ""'UOlit:llJr"'T.'f'll\\ { /0 # Ch d
. ~~Fn_fOR CUll2l6ll lI"1'eaiom:' "777 l. arge Re-
<:1PPer FO~ ~er Footi . ~r~illPliance \\Lith all r!j.9ulations t./. .r:O ReViews
co I LcIi'b5l5esccupancy: :5.3 _ J I
ou h.In eter Bas Final Of~it1\; ;v1M!~O~1Cd.~~RVICES / d- CI oiJ
~ITY OF CAR~'~~:A~LAY TOWNS~g'TAL:_ &- ~i2- 1,
iiity Services (Date) ~.fl-- ~
Fe ceived by: ....-
PROJECT INFORMATION:
Early Release
Permit:
Additional Fees
5'1