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CITY OF CARMEL
PERMIT RECEIPT
OPERATOR: lstewart
COpy # 1
See: Twp:18 Rng:04 Sub: Blk:28 Lot:
PARCEL ID ........: 1610280000039000
DATE ISSUED.......: OS/23/2006
RECEIPT #.... .....: 22126
REFERENCE ID # .... 06050084
SITE ADDRESS...... 13170 HAZEL DELL PKWY #120
SUBDIVISION ......:
CITY .............: CARMEL
IMPACT AREA ......:
OWNER. ...........: PLUM CREEK PARTNERS LLC
ADDRESS ..........: 11911 LAKESIDE DR
CITY/STATE/ZIP ...: FISHERS, IN 46038
RECEIVED FROM ....:
CONTRACTOR .......:
COMPANY. .........:
ADDRESS ..........:
CITY/STATE/ZIP... :
TELEPHONE. ........
SHROUT FAMILY CHIRO.
LIC # SHROUTD
SHROUT, DEREK & MELISSA
185 AMYS RUN DR
CARMEL, IN 46032
(317) 566-0402
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
CIIC/O FLAT RATE 1. 00 107.00 0.00 107.00 0.00
CIIREMOD SQUARE FEET 1,200.00 511.00 0.00 511.00 0.00
ICIIFINAL FLAT RATE 1. 00 100.00 0.00 100.00 0.00
ICIIROUGH FLAT RATE 1. 00 100.00 0.00 100.00 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT : 818.00 0.00 818.00 0.00
METHOD OF PAYMENT
AMOUNT
NUMBER
CHECK
TOTAL RECEIPT :
818.00
1011
~~~------~--
------~-----
818.00
CITY OF CARMEL / CLAY TOWNSHIP
IMPROVEMENT LOCATION PERMIT APPLICATION
For: Remodels & T cnant Finishes: Commercial, Industrial, or Institutional
Permit #: 06050084
Date: 05/23/2006
PARCEL 10 #: 1610280000039000
LOT & SUBDIVISION:
ADDRESS OF CONSTRUCTION: 13170 HAZEL DELL PKWY#120
Township?: 18 Zoning: B3
PROPERTY OWNER INFORMATION:
Name: PLUM CREEK PARTNERS LLC
Ph. #: Fax #:
Street Address: 11911 LAKESIDE DR FISHERS, IN 46038
TENANT INFORMATION:
Name: SHROUT FAMILY CHIROPRACTIC
Address: 13170 HAZEL DELL PKWY #120 CARMEL, IN 46033
CONTRACTOR INFORMATION:
Name: SHROUT, DEREK & MELISSA
Ph. #: (317) 566-0402 Fax #: Email: DRSHROUTDC@SBCGLOBAL.NET
Street Address: 185 AMYS RUN DR CARMEL, IN 46032
CARMEL, IN 46033
Flood Zone: N
Lot Split: N
Plumber's Name:
Codes for Project:
PERMIT TYPE: COMTENANT COMMERCIAL TENANT FINISH
Water Service by: CARMEL County Well Permit #:
Sewer Service by: CARMEL County Septic Permit #:
Foundation Type: SLAB Estimated Cost of Construction: $3000
Manufactured Trusses: N Sump Pump: N
Usage Class: COM Construction Type:
State Design Release #: Square Footage: 1200
SPECIAL CONDITIONS/NOTES:
SHROUT FAMILY CHIROPRACTIC @ HAZEL DELL CORNER LOT
3/PHASE 3 BLDG. PER J.BLANCHARD-NO STATE NEEDED.
"OWNER ALSO WILL BE PULLING A WHITE BOX INTERIOR
FINISH PERMIT ALSO. NO C/O TIL BOTH PERMITS OK.
. NO NOTES'
This permit is valid only if construction conunences within one (1) year of the date of issuance of the State Commercia.l Design Release, All construction
must be completed (CIO issued) within two (2) years of the issuance date.
I, the undersigned, agree that any construction, reconstruction, enlargement, relocation, or alteration of a structure, Of any change in the use of land Of structures
requested by this application will 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 l.C 36-7 et seq, General Assembly of the State of Indiana, and all Acts amendatory thereto. 1 further certify
that only kitchen, bath, and floor drains are connected to the sanital)' se\ver. 1 further certify that the construction will not be used or occupied until a
CertifjcateofOccupancyhas been issued by the Department of Community Services, Carmel, Indiana.
FEES:
COM. IND. INST. C/O
C.1.1. REMODEUTENANT
CII FINAL 100.00
CII ROUGH-IN 100.00
107.00
511.00
APPLICANT NAME:
MELISSA F. SHROUT D.C.