HomeMy WebLinkAbout06040136 Application
City of Carmel/Clay Township Permit #: ()~ DtfO!3~
COMMERCIAL or INSTITUTIONAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Commercial or Institutional: New Structures, Additions, Remodels, Tenant Finishes, & Accessory Buildings
BUILDER of
RECORD:
SE . /fr1
STllEET ADDRESS
'3 g 3</
ClOr
Od
PHONE
"3 i7- 7
FAX
'517-
z -z? Z-~
ZIP
03
STATE
em
J-p1 J "11'( c;
BUllllER'S EMAlL ADDRESS
" ,
PROPERTY
OWNER:
LOCATION
8r. PROJECT
~INFO:
BEST METHOD OF CONTACT:
FAX
STATE
::t-N
ZIP
4t,o
sum # (If Applicable)
$c
"31:;-?,T7 <6", /$'0
WATER lITIUTY > Is SEWER lITIUTY GT~ t> ESTIMATED COST OF CONSTRUCTION:
PROVIDER: C ' PROVIDER: ~ ~... .; z t ~ (EXCLUDING LAND VALUE) I 00 DCO
PLAN COMMISSION / BZA / BPW DOCKET NUMBERS; AND/OR I J 0 0 ....., -r/tC-- () ~
COUmY WELL AND/OR SEPTIC PERMIT #'S (If Applicable): 05 0'-- I I /,lrJl..
# of Aoo,,: Elevator or Uft: Q YES 1<. NO BlllG, CONSTRUCTION lYPE: 11- ~) OCCUPANCY CLASSIFICATION: E.,4- PI>
TYPE OF CONSTRUCTlON: TYPE OF IMPROVEMENT:
o COMMEROAL 0 NEW STRUCTLRE
(PrIvately owned 6illiiifaEAS E 0 F 0 Pftl!lS AODmON' - --"" I
and medical offlcSilli1Brst to ,."":...i!5-- Room(.,)
rd I) (; eN'" .' '. I'
~. arecomme a , ' -,.l.O. Porch>.,...l.::>
lJD"'o INSTm.mON~'l;"~ rf:. 'j! ~.~::! 0 CMezzanineorDeck
o MunidPal~!C13ld9..'.'. ' ." ." f 0 "REMODE~-l'\!Ir.F~
)Zl'>School . ,""o"'NEW'TENANTI'lI'lISA
o Church CITY OF vMIII'._:" O-~AI3((E9sb1WBY~
FOUNDATION TYPE: (Check all which INDll!\I\lAETACHED GARAGE
apply for the new construction area) 0 ATTACHED GARAGE
'ht( SLAB 0 ' CRAWL SPACE 0 CELL TOWER (New)
&POST & BEAM 0 BASEMENT 0 CELL TOWER CD-LOCATE
(or POST & PIER) WALKOUT:_Y_N 0 DEMOUTION
PROJECT INFORMATION:
Early Release ...... Manufactured ~
Permit: Y v N TrusseS: _Y N
Lot Split: Y ,A Sump Pump: _Y N
Does any part of the property ~thin a special Flood
designation area: _Y _\LN'
PLUMBING CONTRACTOR:
Go.dOI\ PIUj",JJ;~'7
Plumber's Indiana State License #:
I00'-13C:>
ctass I structure pennits 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 undersig!1~. ~ 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 Cannel Indiana - 199r (Z'
289) and amendments, adopted under authority of LC. 36-7 et seq, General Assembly of the State of Indiana, and all Acts amendatoI)' thereto. I further certify that only
kitchen, bath, and or drams are connected to e sanitary sewer I further certify that the constructIOn will not be used or occupied until a Certificate of
Occupancyor tJuJ . _1;tion has Issued hy the Departtnent 01 Community ~rvices, Cannd. Indiana. ~ ~
7 . .$/L-~c~~ ~
Signatu Owner o~ uthorlzed Print 0
~, i 'I
., '
OFFICEUSEONLY:************************************************************************
Filing Fees: fj f)~
f~ f TJ itvd# Ch;,'eedwsRe-
Lower Footing Base Inspections: __ c..
Cert, of Occupancy: 1-;//1 r-, f)...,..j HI\,
~- Additional Fees
A TO~AL' ,
A .. ~ i 17. t,,) I c:ur...d
Reviewed Approved:. Dept. of Community Servic Fee elvedby~ ~/~'I 0 1_
S:PermItslFOnnstILP Co"MMEROAL '..J ~ I lP