HomeMy WebLinkAbout06040174 Application
City of Carmel/Clay Township U~rmit #: tJfP.,fJ 46171
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, l!r. Two Family: New Structures, Additions, Remodels, l!r. Accessory Structures
BUILDER of
RECORD:
NAME
PROPERTY
OWNER:
NAME
STREET ADDRESS
LOCATION
l!r. PROJECT
INFO:
LOT #
62..
SUBDIV N NAME
7iV,..IUtc. ('
ADDRESS OF CONSTRUCTION
'0 5'1.::. ~fJ ~,
WATER UTlLrTY /'
t{/-rJt-< PROVIDER: C4. ,<./?, C
SEWER UTILITY
PROVIDER:
PHONE
FAX fy( - <(27- ~
y{- 2'/62-
ZIP
L ~ 2-C(,J
Ol~
SECTION
/il.(IU/f'-.....
SQUARE "i/ V,/
FOOTAGE: r r ,
ESTIMATED COST OF CONSTRUCTION: /
(EXCLUDING LAND VALUE) r /
(jQt/.
(fa
NAME OF LfTILITY EXCAVATION CONTRACTOR; PLAN COMMISSION I BZA I BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'5 (IF APPLICABLE):
PROJECT INFORMATION:
Early Release ~ Manufactured / --r_
Permit: _Y _N Trusses: ......... N
./ 0 CRAWLSPACE
Lot Split: _Y -=::::'N Sump Pump: _Y ~N ~LAB
Does any part of the property lie within a special Flood designation area: _ Y ......,.(
TYPE OF CONSTRUCTION:
o SINGLE FAMILY
J!{l TOWN HOME
o TWO FAMILY
# of units:
o MULTI-FAMILY
# of Units:
o RESIDENTIAL (For
Additions, Remodels, Etc.)
TYPE OF IMPROVEMENT:
D-"'NEW STRUCTURE
o ROOM ADDITION(S)
o PORCH ADDITION(S)
o REMODEL
o ACCESSORY BUILDING
o DETACHED GARAGE
o ATIACHED GARAGE
o DEMOLITION
,r.
Plumber's Indiana State Li
/0 )-r;;cJ 7
,
FOUNDATION TYPE: (Check all that apply for the new
construction area)
o
o
POST & BEAM
BASEMENT
WALKOUT:_Y ~N
For Single Famil~i!lOOY~@llMwO!USililil!.JcG,IJQN.nd/or accessory structures, thisl1er~iri~,,"a~;tT'!y_if. .:cRn.S,ttp,cF. ~.~!'l'~Onitriences
within 180 day5cY eetrtft~ffi'B1~Rcer9ktW~>>g~iormnust be completed (Certificate ?fPff1{P~E-cYl~u<es.!))~tht9'18..T<?,n(h\~f:the
issuance date. CIJS'1' cturt-l?e~rill~~et::B~~.af co~S?eneral Administrative Rules of the State of Inifiana'(See675 -IAG'12).regarding!exp,iration
o ae~l, t ~5" .ngandcompletingconstructiokUJI ijl IiI
I. the undersigned,~P:1iaQ~ GQ:MitltkJ, W n t~.'{.: ent, relocation, or alteration of a ~~r:u,:~ufe, or :_m:..change in the y..se of ~~*d ~f!
structures reques~JriJ~ffl~1DRRKP:i-l~ (C ~qi6<1 Hill applicable laws of the State ofj~ndI,ana, ~-trt ~Zlm~g25'raihance of Gannel
Indiana - 199r (~~)TaM ~m}rlaM~An:arro e er authority of l.c. 36-7 et seq, General Assembly of;rHe stite of Indiana:-and all Acts ameqdathry
thereto. I further certify that only kitchd , , oar drains are connected to the sanitary sewer. I furFhkr t~rjfy~that.the,construction-,.0nrr6t be
used or occupied until a Certificate of Occupancy has been issued by the Department of Community Services, Carmel, Indiana. I
---?2' '/ ~~ " /2 l c: /l Q CE L_ q-';-2Tt..-t, 6
si~r~'of owner or AuthoriZ~ Ptfnt Date
OFFICE USE ONLY: ************************************************************************
Filing Fees: 6-03. /0
INSPECTIONS REQUIRED: -, '0
~ :;:.._ J Base Inspections: ~ ? 7. 5
~pper Foo~ Lower Footing
Cert, of Occupancy: ,';-3. r'O
~9-;;-I2\~e;;;as;J Final P R I F /...z. 6/ () 0 Additional Fees
= __c;/ ~~/O
Fee Received by: ----
,
(' 'rA ,: ~ 11; <. 0 --' . ~ ~ '3 - 0{,
ReViewed/Appro d: Dept. of Community Services (Date)
S:Permits/forms!ILP RESIDENTIAL
# Charged Re.
Reviews