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0605"'0/30
City of Carmel/Clay Township Permit #:
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, &. Two Family: New Structures, Additions, Remodels, &. Accessory Structures
BUILDER of
RECORD:
NAME
j: ~e
( n.\
STREET ADDRESS
9&'.53 .$''< fb,'...fr R.J.
BUILDER'S EMAIL ADDRESS
::r V".,L.'n @ !,;/f!c <0,-,; /rv c ;;~~ ,n,.J
NAME
T::,,,,, Af:,.,-ro,l-/"
PROPERTY
OWNER:
FAX
8'7('",,32
CITY
5), ""j..
STATE
TN
ZIP
L/~Oc;,
BEST ETHOD OF CONTACT:
31V //0- '78
PHONE
</8- t-">o3</
FAX
STREET ADDRESS CITY STATE ZIP
590 t.//!,~ tJ.,. .:I.H 'Itx?
LOCATION LOT # SUBDIVISION NAME SECTION ZONING:
&. PROJECT 333 , Cl.d ,:.k.u
INFO: ADDRESS OF CONSTRUCTION SQUARE :28f3
1"$ ../ rf C4.f"P11" FOOTAGE:
SEWER UTILITY WATER UTILITY ?,;y ESTIMATED COST OF CONSTRUCTION: 1- CI, 0::>0. ""
PROVIDER: PROVIDER: (EXCLUDING LAND VALUE)
NAME OF UTILITY EXCAVATION CONTRACTOR; PLAN COMMISSION I BZA / BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'S (IF APPLICABLE):
Manufactured
_Y _N Trusses: _Y _N
o CRAWLSPACE
Lot Split: _Y _N Sump Pump: _Y _N 0 SLAB
Does any part of the property lie within a special Flood designation area: _ Y ~N
TYPE OF CONSTRUCTION:
o SINGLE FAMILY
o TOWN HOME
o TWO FAMILY
# of units;
o MULTI-FAMILY
# of Units:
)6 RESIDENTIAL (For
Additions. Remodels. Etc.)
PROJECT INFORMATION:
Early Release
Permit:
TYPE OF IMPROVEMENT:
o NEW STRUCTURE
o ROOM ADDITION(S)
)& PORCH ADDITION(S)
o REMODEL
o ACCESSORY BUILDING
o DETACHED GARAGE
o ATTACHED GARAGE
o DEMOLmON
PLUMBING CONTRACTOR:
_YZ-N
Fo~ Si~gle F~r.tt.:r.~. ...-~~jly..Q. w.J;:lli:qg:;;.-<uld.iV?~;:;QQqels, and/or accessory structur~s: this permit is valid, only if c~ns~ruction commences
wIthm ISO _ _' _ _ _ _I!iIiWcrUH~1:IJii&i'l\g~dW.(N, and must be completed (Certlftcate of Occupancy Issued) wIthm 18 months of the
issuance datcS.\#,~JPii~wi$hl1JUh.~l A~m.inistrative Rules of the State of Indiana (See 675 lAC 12) regarding expiration
'"'. . of Sta,tetand LO,oal ~S';mes for beginqing and completing construction.
I, the undersi~~~tJJ,a~~9f1sJi~UNt\q~~lil(a~~rgement, relocation, or alteration of a structure, or any change in the use of land or
structures rcqM~J]y ~~~~.~XJ~i'1I~mpl}~ M'r!M~rm to, all applicable laws of the State of Indiana, and the ~Zoning Ordinance of Carmel
Indiana" I9Gl'fl!(f€l~~q <@l!Alful:<€iWNSI1IIIPIc. 36.7 et seg. General Assembly of the State of Indiana. and all Acts amendatory
thereto. I further certify that only \4~.1 1ief.k.., and floorjiliains are connected to the sanitary se"\ver. I further certify that the construction will not be
used or oc ied until a CertjHdfi!l~~~ncy has been issued by the Department of Community Services. Carmel, Indiana.
. . ::ru..s -I~ R K'v.<; Jr, .s/n J:,(p
Print' Da~ '
FFICEUSEONLY: *********************************************'~******~*****************
Filing Fees: / b ~. (/ Q
INSPECTIONS REQUIRED: -// / ;?) # Charged Re-
Base Inspections: -I:Z ra "
Upper Footing Lower Footing Under Slab . -;II ReViews
Cert. of Occupancy: . ':;-.3_<(/
Meter Base
Final
Site
P.RJ.F.: Additional Fees
~ ~A\t !:13P.06 _
fJI " L)2-c:; '-J =I) '"
Fe Recei ed by: I
s- Q- ~
Reviewed/Ap eyed: Dept. of Community Services (Date)
S:PermitsjForms/ILP RESIDENTIAL