HomeMy WebLinkAbout06050001 Application
City of Carmel/Clay Township (/.~ Permit #01005000 \
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, & Two Family: New Structures, Additions, Remodels, & Accessory Structures
PROPERTY
OWNER:
NA
FAX
BUILDER of
RECORD:~
~fo.I\'~ .
STATE
ZIP
FAX
STATE
ZIP
7'h"J).
LOCATION
& PROJECT
INFO:
SEWER UTILITY WATER UTILITY
PROVIDER: 5. I ( /'\ PROVIDER:
NAME OF UTILITY EXCAVATIOt!.' . CTOO;" PLAN COMMISSION / BZA! BPW DOCKET
NUMBERS; TAC DATE(S); ~I'i~ %U W: AND/OR SEPTIC PERMIT #'S (IF APPLICABLE):
~ \
/.... \
TYPE F ON . : . PE OF IMPROVEMENT'
o /SI.~GLr~~t.fr(y I:l~\ 06J NEW STRUCTURE '
~~TQWN'HOME \ 't(j ~\ ROOM ADDITION(S)
\'. FAMIL~ .. D) PORCH ADDITION(S)
.\qf\uni1'$.~ .... /'0 REMODEL
o \,U,t.'f!';FAMILY / 0 ACCESSORY BUILDING
It,<?f'~. Its: 0 DETACHED GARAGE
C1i( RESIDEN AL(Fo 0 ATTACHED GARAGE
Addlt!ons, R els, Ete.) 0 DEMOLITION
\ '
PROJECT INFORMATION:
ESTIMATED COST OF CONSTRUCTION:
(EXCLUDING LAND VALUE)
PLUMBING CONTRACTOR:
Plumber's Indiana State License #:
Which plumbing codes will be applied to the construction:
o International Residential Code wI Indiana Amendments
o Uniform Plumbing Code w/Indiana Amendments
(Multi-Family Construction Code)
Early Release
Permit:
_Y~N
_Y~N
Manufactured
Trusses:
~Y_N
>< Y _N
FOUNDATION TYPE: (Check all that apply for the new
construction area)
[g CRAWLSPACE
[51( SLAB
nation area: _ Y ...2(..N
o POST & BEAM
o BASEMENT
WALKOUT:_Y ~N
For Single Family and wl2J ami ~1Itp.ge,~tWRhmP1~~a~~saccessory structures, this permit is valid only if construction commences
within 180 days orch l~~Pfs a e ofihe I cfi"n 1a~sand must be completed (Certificate of Occupancy issued) within 18 months of the
issuance date. Class I structure p~ ~ . :tq91~eneral Ad)J.l~Bt~ative Rules of the State of Indiana (See 675 lAC 12) regarding expiration
~PT OF COM~~t&lEij}'(1~~completingconstruction.
I, the undersigned, agr ~. co c', W t-p:ution, or alteration of a structure, or any change in the use of land or
structures requested byt: , a p~!8t t~Imrm ~pplicable laws of the State of Indiana, and the UZoning Ordinance of Carmel
Indiana -1993" (Z- 289) and amendments, ado" lAblAthority of l.c. 36~7 ct seq, General Assembly of the State of Indiana, and all Acts amendatory
thereto. I further certify that only kitchen, bath, and Ooor drains are connected to the sanitary sewer. I further certify that the construction will not be
used or pi d nntil ':- Certifjc;re of Occupancy has been issue the Department ~~:mmunitY Services, Carmel, Indiana. ~,,6 t?
o e
OFFICE USE ONLY: *************
P.R.I.F.: Additional Fees
TOTAL: ,g -j/7//0
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