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City ofCarmel/C/ay Township Permit #:~rx;001&
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-F
BUILDER of
RECORD:
NAME
STREET ADDR
PROPERTY
OWNER:
STREET ADDRESS
LOCATION
1ft PROJECT
INFO:
SEWER lJTIUTY /J
PROVIDER: c'tJ..JLIruL
NAME OF lfT1LfTY EXCAVATION CONTRACfOR; PlAN COMMISSION I BZA / BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'$ (IF APPLICABLE):
TYPE OF CONSTRUCTION:
Q SINGLE FAMILY
A TOWN HOME
o TWO FAMILY
;. M~~~~~~~I~Y
# of Units:
o RESIDENTIAL (Fa
Additions, Remodels, Etc.)
TYPE OF IMPROVEMENT:
~ NEW STRUCTURE
o ROOM ADDITION(S)
o PORCH ADDITION(S)
o REMODEL
o ACCESSORY BUILDING
o DETACHED GARAGE
o ATTACHED GARAGE
o DEMOLITION
PROJECT INFORMATION:
Early Release
Permit:
New Structures, Additions, Remodels, 1ft Accessory Structures
PMONE
FAX
CITY
STATE
ZIP
BEST METHOD OF CONTACT:
FAX
CITY
STATE
ZIP
ZONING:
SQUARE /) H //6-
FOOTAGE: dJ / ~..
Plu er's In "ana State License #:
JtJ)CM57
Jb "A
0,. /" ~ p.,,;~1t,,
'.~ :,:9-6'..."-
07 ~ ~,.
>'13
:.>,.
Which plumbing codes will be applied to the construction:
o International Residential Code w/lndiana Amendments
~ Uniform Plumbing Code wi Indiana Amendments
(Multi-Family Construction Code)
)( Manufactured.X FOUNDATION TYPE: (Check all that apply for the new
construction area)
Y N Trusses: _Y _N J
- 7 0 CRAWLSPACE 0 POST & BEAM
Lot Split: _Y _N Sump Pump: _Y -X-N ~SLAB 0 BASEMENT
Does a l!A~l!l~ON&TIIltUCs~ Flood designation area: _ Y.LN WALKOUT:_ Y_N
For Sin~~ 1Rt&:l? lIJM~Jlci~ . ~ons. remodels, and/or accessory structures. this permit is valid only if construction commences
within 180 days 61fftSlEIl&.M%ltaHt l"8e" fipgllEi'iffiit, and must be completed (Certificate of Occupancy issued) within 18 months ofthe
i~suance t,,~.p:taep(:9~M\:.,bU"Dl - "~neral Administrative Rules of the State of Indiana (See 675 lAC 12) regarding expiration
" _.' ' MI=I I r.1 A"Y ~H~eginning and completing construction.
I, the u~QfigCAR try't:t*1s't1~tion, reconstruction, enlargement, relocation, or alteration of a structure, or any change in the use of land or
structures requested by this a~IA~comply with, and conform to, all applicable laws of the State of Indiana, and the "Zoning Ordinance of Carmel
Indiana - 1993" (Z- 289) and amendments, adopted under authority of r.c. 36~7 et seq, General Assembly of the State of Indiana, and all Acts amendatory
thereto. I further certify that only kitchen, bath, and floor drains are connected to the sanitary sewer. I further certify that the construction will not be
use or occupied until G.ertificate of Occupancy has been issued by the Department of Community Services. Carmel. Indiana.
." Sf/AIJA/OM IILW/-IfJ/A! 5- /-o.u
Sign ture 0 0 ner or Author Print Date
OFFICEUSEONLY:************************************************************************
f.{ ..)Filing Fees: ft (0 3, SO
INSPECTIONS REQUIRED" f)\\C . -, N 7 ~ r",
'J Base Inspections: ""'-1' '-J V
Lower Footing Under ::>,ao ., '-~ 3 , 50
e Cert. of Occupancy: ~
ete; Ba~e Fi .K ~ 7 ./J 0
P,R,LF,: :...J
,
5;ZI,5"O
# Charged Re-
ReViews
Additional Fees
-I t---o.{,
ReviewedjApprov d: Dept. of Community Services (Date)
S:Permits/Forms/IlP R IDENTIAl