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City of Carmel/ Clay Township Permit #: 0 (p ()L/, DI73
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, &. Two Family: New Structures, Additions, Remodels, &. Accessory Structures
BUILDER of
RECORD:
NAME
i
PHONE J 16- :21t2
"'~~
FAX
?Y6- Y2-2-Y
PROPERTY
OWNER:
STREET ADDRESY] P
7UJ.-r P. 1I('~'tfl
ZIP
NAME
STREET ADDRESS
LOCATION
&. PROJECT
INFO:
SECTION
ej....f-,!,Il'1
~,I~G" "
SQUARE E') J /
FOOTAGE: P-I ~I
SEWER UTILITY /: .
PROVIDER: l V--(- In- '- (
WATER UTILITY /.
PROVIDER: C-t/../t /1< .( (
ESTIMATED COST OF CONSTRUcnON: I 1(, _~
(EXCLUDING LAND VALUE) II tf ()O.
NAME OF UTILITY EXCAVATION CONTRACTOR; PLAN COMMISSION I BZA / BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'5 (IF APPLICABLE):
TYPE OF CONSTRUCTION:
o SINGLE FAMILY
):?tJ TOWN HOME
o TWO FAMILY
# of units:
o MULTI-FAMILY
# of Units:
o RESIDENTIAL (For
Additions, Remodels, Etc.)
TYPE OF IMPROVEMENT:
cr--NEW STRUCTURE
o ROOM ADDITION(S)
o PORCH ADDITION(S)
o REMODEL
o ACCESSORY BUILDING
o DETACHED GARAGE
o ATTACHED GARAGE
o DEMOLITION
"'-
Plumber's Indiana State
/ (/'}7'rJ '1'
PROJECT INFORMATION:
Early Release ~ Manufactured / ~ N
Permit: _Y _N Trusses: '--y
./ ~ 0 CRAWLSPACE 0 POST & BEAM
Lot Split: _Y ~ Sump Pump: - Y =N 9'SLAB ~ 0 BASEMENT ~
Does any part of.f1ERfM@SOi~i!leMS'PPl'lJ ignation area: _ Y _N WALKOUT:_ Y_N
For Single Family an u,% ~i~'2aJBHfi~ficllYltR,~,I.l!Mi~or accessory structures:>jp.ls:pifr~it~~al~_~~only.~f.~nst~E!!J.~.~,ommences
. within ISO days of the date &1~~e&/Il~~66l1l:ti~jt, and must be c~mpleted (Certi~icatf\of p~~P?~I)Cx.i.~lf~d)\~th1~l'I~ .l!1';'::"ths o~ th~
Issuance date, Class D~"lI€)fer@i0~N'lO/Is~.1}I &nistraUVe Ru~es of the St~t} prlndIana'.(Sec 6Z?~C:: 12).regard~.n g. eXpIratIOn
. r.ITV nl='.~A~~1I pJ:Q~f~;\IJ1esTdr\lIe~lllm andcor~pletlllgcon~trtc.P9~' . Jll 1.,
I, the underSIgned, ~ ~e th<h':1n~rMt~a, te~tibQW , elocatlOn, or alteratlor-;9f,ais~rucrure, or any change III the ~s~ of l~nd or
structures requested by this application wINID4~h, and"conf~.rm to, all applicable laws of the :f~t~ 9flndi~l1n1t?ei2~ Orcf~;anf~;of Carmel
Indiana - 1993~ (2-289) and amendments, adopted under authority of LC. 36-7 et seq, General AsscD}l?ly 9~ ~he State of Iniliana/anCl'dll ACf~ a~7l}datory
thereto. I further certify that only kitchen, bath, and floor drains are connected to the sanitary sewei. II further certify that the construction'will not be
used or occu ied until a Cer Beate of Occupancy has bl7en issued'by the Department of Commpnity S'e"..vices, Carmel;"Indiana:--.J '--'" I
Y .-!/ l G-tf,p C~'--- \.1-~~7-o'
P,(nt
FOUNDATION TYPE: (Check all that apply for the new
construction area)
Date
OFFICEUSEONLY:***********************************************>************************
Filing Fees: ~ CD 3 _ / GJ
INSPECTIONS REQUIRED: # Ch d
__. ,- J Base Inspections: ~ -;?? -5'0 arge Re-
Upper Footing Lower Footin<Under ~ :> . Reviews
- Cert. of Occupancy: <j3_ 5'0
CRuuy", ~ ~ ~al ~ P.R.LF.: / OJ C/ &10
~ /:9.5_ /0
,
Additional Fees
I
Cra-~ ~ 1-1J~ S- - :S-q,
ReviewedjAppr ed: Dept of Community ServICes (Date)
S;Permits/FormsjILP RESIDENTIAL
TOTAL:
Fee Received by: