HomeMy WebLinkAbout06040179 Application
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City of Carmel/Clay Township clMpermit #: tV feJ)L(OI11
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, 8r. Two Family: New Structures, Additions, Remodels, 8r. Accessory Structures
BUILDER of
RECORD:
BUILDER'S EMAIl ADDRESS
111. C" (" '"
BEST METHOD OF CONTACT:
.- - "'Y1r."< 0/
NAME
PHONE
Yb-7-7b 2..
FAX J1'6' ~ VL2y
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PROPERTY
OWNER:
NAME
~
STREET ADDRESS
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SUBDIVISION NAME /
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LOCATION
8r. PROJECT
INFO:
LOT #
ADDRESS OF CONSTRUCTION
vir
':>k ~.ly
WATER UTILITY /' /
PROVIDER: L t{ ,,( ryt e .
SQUARE eq
FOOTAGE: L / 'f I
/1 cJ C/o _ () cI
SEWER UTILITY
PROVIDER:
(~fli'q (
NAME OF lfTlLfTY EXCAVATION CONTRACTOR; PLAN COMMISSION I BZA I BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'5 (IF APPLICABLE):
o
o
o
o
o
o
o
MPROVEMENT:
NEW STRUCTURE
ROOM ADDITION(S)
PORCH ADDITION(S)
REMODEL
ACCESSORY BUILDING
DETACHED GARAGE
ATTACHED GARAGE
DEMOLITION
-I ~ .~I!/Q/C-
PLUMBING CONTRACTOR:
TYPE OF CONSTRUCTION:
o SINGLE FAMILY
~OWN HOME
/0 TWO FAMILY
# of units:
o MULTI-FAMILY
# of Units:
o RESIDENTIAL (For
Additions, Remodels, Etc.)
.,e<
Plumber's Indiana State License #:
/05 ,?d 9
PROJECT INFORMATION:
Early Release ,/" Manufactured ./
Permit: _ Y ---.p Trusses: _ Y _~
./ <-' 0 CRAWLSPACE 0 POST & BEAM
Lot Split: _Y _N Sump Pump: _Y _N ~B . :/" 0 BASEMENT
Does any part of the property lie within a special Flood designation area: -'- Y N WALKOUT:_Y '--"f\J'
l~----'-----"" .
For Single Family and Two Family dwellings, additions, remodels, and/or accessory structures, thi~ii?er:~i~7ii.v'iiff'o~jyjf~o~~J?u~ti6n\c'om.r~ences
within 18E~l!!w i'f.~' a~ffi f~~~lqi.lJ.lU19:..l\!if' and must be completed (Certificate. :~f <?f~uI'-ancYis-slied)-witliiri"l8m?r:th'~i.0f the
issuance da . '~r'nHu&l , ~\ate~t.lct~I~lN:ral Administrative Rules of the State;~f-Iti~~ana (See 675 lAC 12) regarding e?4>iration
U J8Ct to camp lance with alhrce{Btlia:aMlPeginning and completing constructii?~T\,t 11 .t .[1 "lr\ j!! ill
I, the undersigned, agrOf $Wite)(mdsUoomr()OOe~,ruction, enlargement, relocation, or alteration of J:,k~;~t;Ire, or.R'ny cM:ngl i~he.use of Plll~,or
structures rem~lF: crpljt;;:<AtA9A ~1~M ,wj.th,AlJ4~form to, all applicable laws of the State.l~ IrLq~ana, and the "Zoning Ordinan7~Lefmel
Indiana -I~" - ~9 and am'tdd'M~h'r(':lI:lc:fpteCftthde\"~Hi"",~ of I.e. 36~7 et seq, General Assembly cif the State of-lndiana,.and,all.AHs,amendatevr
thereto. I ~ e cbt y{hA,EiihflEkh/:rCl:JaA,)fnl@W<NS:HfP:onnectedtothe sanitary sewer. I fJrther certify that the construction will not be
used or cecu ie~ un~il ~ertjfifNofAAlfancy has been issued by the Department of Community.Services,.Carmel,.Indiana.w____.._.-J
/: ,.L7/l-P C c: If cJ C E l/ ~2. 7 <J (,
Signa ure of Owner or Authoriz gen Prirl't Date
FOUNDATION TYPE: (Check all that apply for the new
construction area)
OFFICE USE ONLY: ******************************************************'*****************
Filing Fees: r:n3 . / {}
ECTIONS REQUIRED:
.
Reviewed/Appro d: Dept. of Community Services
S:?ermitsjFormS/ILP RESIDENTIAL
c
TOTAL:
~7?:;(;
:> ? so
/ ;;; (,/ cJ()
( .
..#' r5?/9//0
# Charged Re-
Reviews
nder"Slab
Base Inspections:
Cert. of Occupancy:
Upper Footin Lower Footing
~U9hI~ f"
Site
P.R.I.F.:
Additional Fees
(Date)
Fee Received by: