HomeMy WebLinkAbout06060023 Application
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City of Carmel/Clay Township lV ~ v Permit #:0(;,OhOO:<.:3
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, &. Two Family: New Structures, Additions, Remodels, &. Accessory Structures
BUILDER of
RECORD:
NAME
STREET p~s
BUILDER'S EMAIL
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PHONE .-
S7
CITY
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FAX
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STATE
ZIP
BEST METHOD OF CONTACT:
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PROPERTY
OWNER:
NAME
STREET ADDRESS
LOCATION
&. PROJECT
INFO:
LOT #
'-I
SUBDIVISION. N~E
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SEWER UTILITY
PROVIDER: cf;2-w (
CITY
STATE
ZIP
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~ING ~CTOR:j) / /
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Plumber's Indiana State License #:
1! R'o7o Or::. 8' a
o Which plumbing codes will be applied to the construction:
o 0 ~ational Residential Code wI Indiana Amendments
0'Uniform Plumbing Code wI Indiana Amendments
(Multi-Family Construction Code)
N'
Early Release ~'M ufactured / FOUND~TION TYPE: (Check all that apply for the new
P"t Y ~ Y N construction area)
erml : russes:
. - - /""'- 0 CRAWLSPACE 0 PJlli'f & BEAM /
Lot Split: _Y Sump Pump: ~ _N 0 SLAB .-- /' ~ASEMENT ~
Does any part of the property lie within a special Flood designation area: _ Y -0, WALKOUT:_ Y_N
For Single Family and Two Family dwellings, additions. remodels, and/or accessory structures. this permit is valid only if construction commences
within 180 days of the date of issuance of the building permit, and must be complcted (Certificate of Occupancy issued) within 18 months of the
issuance date. Class I structure permits arc subject to the General Administrative Rules of the State of Indiana (See 675 lAC 12) regarding expiration
time frames for beg~5~ and completing construction.
I. the undersigned. agree ~hat any co.nstru~tion, recon~truction. enlar 1t~Ii)' ~OO"a~~\.':Je'1'1A't\~ange in the ~se of land or
strucrures requested by thiS applicatIon \\'111 comply \\'lth, and conforrso~~~W!lL~~,t.a!~ of lana,~r\jl1hl' ~Zoning Ordmance of Carmel
Indiana - 199r (Z- 289) and amendments, adopted under authority of I.c. 36:-ie(~,~ -;!.,9:! rarA~, e 1'A't~ 'df r~~",,~a, and all Acts amendatory
thereto. I further certify that only kitchen, bath, and floor drains are c~~cted tb"th~ ,gn~lfilf1~\ .CpttGmGe:irrify that the construction will not be
used or occupied until~cate Occupancy has becn iSsucCr~f\Te~~~~eE5ln,diana.
Signature of Owner or Authorized Agent NO j NA Da
OFFICE USE ONLY: **************
P.R.I.F.:
Reviewed proved: Dept. of Community Services
S;Permits!forms/IlP RESIDENTIAL
(Date)
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9 Fees: I/O. /0
.;2 7"7 . <; tJ
.
03 ::-0
I J- 61 cJO
# Charged Re-
Reviews
Additional Fees