HomeMy WebLinkAbout06050153 Application
City of Carmel/Clay Township Permit #: 6 (p 066 L63
COMMERCIAL or INSTITUTIONAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Commercial or Institutional: New Structures, Additions, Remodels, Tenant Finishes, &. Accessory Buildings
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FAX
BUILDER of
RECORD:
NAME
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STATE
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STREET ADDRESS
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ZIP
BUILDER'S EMAlL ADDRESS
PROPERTY
OWNER:
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STREET ADDRESS
06 Z_
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BEST METHOD OF CONTACT:
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FAX
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STATE
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ZIP
LOCATION
& PROJECT
INFO:
ADDRESS OF CONSTRUCTION
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SUITE # (If Applicable)
o
Address of Shell Building (If different than Address of Construction)
Co +e.. e I,C."-.
SCOPE(S) OF
RELEASE: 0 ELEC
Lot # and SubdivisIon (If Applicable)
BUILDING, PROJECT, OR TENANT NAME:
W l ;10"-
STATE COMMERCIAL
DESIGN RELEASE #: (1-- Eo"\-
WATER UTlLTIY
PROVIDER: ~
o MECH
o
TAX MAP PARCEL #:
1''1 13 -J;! -60..00..011_00
SQUARE Il/?l L;;J
FOOTAGE: Lf/ ,- U
D .:onf, C!ij\j ST c ESI1.MA'l'EjrGOST OF CONSTRUCTION:
-P J: -, (EXCLUOlf.iG lAND VALUE)
.11::: n 'P Wlt~ '.11 "r;' ,_,I . ons
PLAN COMMISSION / BZA / BPW DOCKET NUMBERS; AND/OR of State and Loccl (;o[,e;,.
COUNTY WELL AND/OR SEPTIC PERMIT #'S (If AppllcablebEPT OF COMMUNITY :':'c.R\liCES
# of Floors: Le Elevator or Uft: i( YES /.p0! - ~~0,N~~:\y TOV. NSH i OCCUPANCY CLASSIFICATION:
TYPE OF CONSTRUCTION: PE OF IMPROVEMI!lII ,I NA PROJECT INFORMATION:
~ COMMERCIAL NEW STRUCTURE Early Release .v
. (Privately owned hospital i! i ADomON Permit: _y ~N
and medical offlceS/ce rs ~ ' < 0 Room(s)
are commercial) t"./ 0 Porch Lot Split: _Y ~N Sump Pump: _Y.3;...N
o INSlTIUTIONAL . ,,/ 0 Me~anl'ne or Deck of h I" h' . I I d
~ - Does any part t e property Ie WIt In a specla F 00
o Munidpal/Pu lie Bldg / 0 REMODEL
o School /' ~NEWTENANTFINISH designation area: _Y f.... N
o Church" 0 ACCESSORY BUILDING PLUMBING IJN/T~OR:
FOUNDATION TYPE: (Check all which 0 DETACHED GARAGE
apply for the new construction area) 0 AlTACHED GARAGE
~ SLAB 0 CRAWL SPACE 0 CEUL TOWER (New)
o POST & BEAM 0 BASEMENT 0 CELL TOWER CO'LOCATE
(or POST & PIER) WALKOUT:_Y_N 0 DEMOLITlON
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Manufactured y
Trusses: _ Y .::,LN
Plumber's Indiana State License #:
Class I structure pennits are subject to the General Administrative Rules of the State of Indiana (See 675 lAC 12) regarding expiration time hames for
beginning and completing construction.
I, the undersigned, agree that any construction, reconstruction, enlargement, relocation, or alteration of a structure, or any change in the use of land or structures
requested by this application will comply with, and conform to, all applicable laws of the State of Indiana, and the "Zoning Ordinance of Cannel Indiana - 1993'" (Z~
289) and amendments, adopted under authority of I.e. 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 used or occupied until a Certilicate of
(~Substanda[ f 'PIe' 5 oeenissnedbytbeDep",,:,~o:communityservic~'ICannel.~diana. S--,g--D(..
L.Jo-' ~, DJJ~ c..... '=FP=" r ,.'t-- ,~
Signature of Ow or A 'thortzed A ent Print ~ Date
OFFICEUSEONLY:************************************************************************
INSPECTIONS REQUIRED: Filing Fees: .5 9'1 ~ to 0
-7 0 ", F) # Charged Re-
Upper Footing Lower Footing Under Slab Base Inspections: ^ 0,. L/ V Reviews
~ Meter Base ~ Site Cert. of Occupancy: I ~ 7 6- c!l 0
.~ 'n / / IJ Additional Fees
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Fee Received by: 'Ll2/...lf
pproved: Dept. of Community SelVices
ILP COMMERCIAL
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