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PAGE 1 of 2. •
BC Form - 1972,0ct.
APPLICATION FOR ARCHITECTUPJUJ DESIGN AND LIGHTING
Town of Carmel-Clay Township, Hamilton County
Building Commissioner's Office / 130 First Avenue S. W.
DATE FILED
The undersigned agrees that any construction, reconstruction, enlargement, relocation
or alteration of 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-1961 ", adopted under the authority
of Chapter 174 of the Acts of 1947, General Assembly of the State of Indiana, and all Acts
amandatory thereto.
1 . LOCATION OF REAL
ESTATE ON WHICH STRUCTURE IS TO BE LOCATED:
Address: (W/ ,Towns hip:
Legal Description: Lot No. ,Addition:
Other description of Location: � � .-.O -a -w
,Zoning:
2. APPLICANT:
,C-7 l�
Name: V4-70-0-4-'11 ,*�` Phone No. 773 -
Address: C/ocjch 44, Eovr 4 /ta A4;.0/G4e
Owner of Real Estate on which Structure is to be located:
Name: ,(4,L" Phone No.
Address:
3. DESIGN INFORMATION:
Type of Business 1f t► 1 j
Exterior Finish of Building:
TYPE OF MATERIAL COLOR
Front: 27'2
Sides:
Pack:
Style of Roof: ` ,,me.- s� �r
4. PARKING LOT:
1 . Type of Material ,2. No. of Parking. Spacesael.4.4Vl-0.
3. Concrete Curbs
5. PERIMETER LIGHTIIdG: ;4 ate,
Type of Lighting: Florescent , Mercury Vapor , Incandescent
Adjustable or Nonadjustable lamps.
Beam Spread in Degrees
No. of Lighting Fixtures Overall Height Watts Volts
-1 -
a .
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6. Additional Requirements:
7. Application Fee of $ j S ast accompany this application. Late Fee $ .
Permit Fee $ .
Permit Fee received by
Title
DATE:
THIS SECTION TO BE COMPLETED AT TIME OF APPROVAL
8. CERTIFICATION:
I CERTIFY THAT THIS STRUCTURE AND LIGHTING WILL BE ERECTED AND MAINTAIN'
IN ACCORDANCE WITH:
1 . The statements made on this document and plans filed with application for permits.
2 . The Zoning Ordinances of Clay Township, Hamilton County.
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