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City of Carmell Clay Township Permit II() foO.')/) lk q
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, lk Two Family: New Structures, Additions, Remodels, lk Accessory Structures
BUILDER of
RECORD:
R GJVltlI)liil.JH /;
PHONE
FAX
]1]-,7 --0'117
STREET ADDRESS
75"ifO
CITY
STATE
ZIP
BUILDER'S EMAIL ADDRESS
BEST METHOD OF CONTACT:
PROPERTY
OWNER:
7Nl'lt:
NAME
Nt
PHONE
J:= 317- C;io1-000 I
FAX
STREET ADDRESS
CHt::<JSTlN/f
CITY
C Ih'\tvI CL
STATE
/1
ZIP
LOCATION
lk PROJECT
INFO:
e~
SECTION
ZONING:
5-2
SQUARE
FOOTAGE:
SEWER lfTlLryr}/! ;J
PROVIDER: C:~.
NAME OF lJT1LTTY EXCAVATION CONTRACTOR; PLAN COMMISSION / B
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PER
TYPE OF CONSTRUCTION:
o SINGLE FAMILY
o TOWN HOME
o TWO FAMILY
# of units:
o MULTI-FAMILY
# of Units:
r;o RESIDENTIAL (For
Additions, Remodels, Etc.)
TYPE OF IMPROVEMENT:
ESTIMATED COST OF CONSTRUCTION;
(EXCLUOINGr""NDVAmEr::~:_~:::-'~'-'2-t,.:::O f).A-.,
11r,\ !;....,-.:J /! '.. j",' 11 ,,:, J." );[-,
,I i I ,..._.....J -"::./ \_';--" ;,1 '" .__":::; '. \ j
1111..; --.--------~-----li',- Iii;
._ .1 . I
PLUMBING C N' .RAc\I0)l.: 2 3 2009 }!.~ ;(<,1);1
. : . ~t/i tf.) rJJ.!j(fl'{tl"d? ~
Plumer'(fJd~a State ~e . Se #: j
fu ~ rJ-fb-. ~.______~__J
Which pl~ codes will be applied to the construction:
~mational Residential Code wjlndiana Amendments
o NEW STRUCTURE
o ROOM ADDITION(S)
o PORCH ADDITION(S)
rp REMODEL
b ACCESSORY BUILDING
o DETACHED GARAGE
o ATTACHED GARAGE
o DEMOLITION
PROJECT INFORMATION:
Early Release _~ ~Manufactured
Permit: _Y _N Trusses: _Y):2N
o CRAWLSPACE 0 POST & BEAM
Lot Split: ~Y -)Q.N Sump Pump: --JQ-Y _N 0 SLAB ~ BASEMENT
Does any part of the property lie within a special Flood designation area: _ Y ~N WALKOUT:_ Y t!C? N
For Single Ai~ "... .."' ,ltion~t\'~w1els, and/or accessory structures, this permit is valid only if construction commences
within 186dJbietfttttt Co6'lp~~~~i Jjf~Y~e'rlMft, and must be completed (Certificate of Occupancy issued) within 18 months of the
issuance date.- Crass It!!i'rStrJtI18tit11li6)0a:1~~ the General Administrative Rules of the State of Indiana (See 675 lAC 12) regarding expiration
T (.':\1:: ;~^MiA'I~iN'lwen:.~cginning and completing construction.
I, the,unders~ <w~tha'F"a'r1Y ?2,IJ{~t'fUcqO'l'{$~_", ," 'f1;.1 i~ ~gement, relocation, or alteration of a structure, or any change in the use of land or
structures ~OFt~M5lw,(.v(il~plyl,\WK,"a'rl~&U&m to, all applicable laws of the State of Indiana, and the "Zoning Ordinance of Carmel
Indiana -!9"t13"'(Z>289) and ame~l~mtedulnde'r authority of r.c. 36-7 et seq, General Assembly of the State of Indiana, and all Acts amendatory
~hereto. I further certify that only"'td1~en,'b~'th. and floor drains are connected to the sanitary sewer. I further certify that the construction will not be
. used or occupied until a C . ica.te ofOccupa.ncyhas been issued by the Department of Community Services, Carmel, Indiana.
~- V T!f()/V//7S D. K/~~c..iI
Print
o Uniform Plumbing Code wI Indiana Amendments
(Multi-Family Construction Code)
FOUNDATION TYPE: (Check all that apply for the new
construction area)
Si
re of Owner or
v
'7/21./~6
Date
~
OFFICE USE ONLY: ******~*,*.**-****** ************ *** *************7**** ***~** *************
,: ' Filing Fees: 3 '3 ) 0
INSPECTIONS REQUIRED: I / /j 0 Ch
Base Inspections: L..- 0 # .rged Re-
Upper Footing Lower Footing Under Slab ( . -/7 Reviews
Cert. of Occupancy: S~. )0
. -ou~ Meter Base fiffiij---.Site)
~ '---_ ~ P.R.I.F.:
="~~~,? Q'
Additional Fees
e \r6-;~ H/s~ '5-2b~c>b
Reviewed/Approve: Dept. of Community Services (Date)
S:Permits/FormS/llP RESIDENTIAL