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City ofCarme//C/ay Township Permit #:OttJ61J J'g i
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, & Two Family: New Structures, Additions, Remodels, & Accessory Structures
BUILDER of
RECORD:
FAX
ZIP
Y
PROPERTY
OWNER:
STREET ADDRESS
\'i
STATE
.:LV
ZIP
4003
S'-
LOCATION
& PROJECT
INFO:
LOT #
SEmON
h
ZONING:
SQUARE
FOOTAGE: ')d2-Y
ESTIMATED cosr OF CONSTRUcnON~
(EXCLUDING IJ\ND VALUE) f t;; 00 0
NAME OF UTILITY EXCAVATION CONTRACTORi PLAN COMMISSION / BZA I BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR CDUNlY WELL AND/OR SEPTIC PERMIT #'S (IF APPLICABLE):
TYPE OF IMPROVEMENT:
~ STRUCTURE
DOOM ADDITION(S)
PORCH ADDITION(S)
o REMODEL
o ACCESSORY BUILDING
o DETACHED GARAGE
o ATTACHED GARAGE
o DEMOLITION
...<
PLUMBING CONTRJ\6TO~ ce-l' r; , PI '~\.? 'I ,::;\!
I. ') __:J -...;. \_.;" \" I \.;
li'l : r. - -- -------...----1\1 1 \ 1
! \ ) I ill i:1
Plumber's Indiana Sili IcenjU~: 2 3 2006 III i/
Which plumbing code. will' LI.p - lUa.the-rnn'''ucti..' '----' \
o International Resid ntial Code w/Indiana Amendmen~
o Uniform Plumbing Code wI Indiana Amendments
(Multi-Family Construction Code)
TYPE OF CONSTRUCTION:
o SINGLE FAMILY
o TOWN HOME
o TWO FAMILY
# of units:
o MULTI-FAMILY
# of Units:
o RESIDENTIAL (For
Additions, Remodels, Etc.)
PROJECT INFORMATION:
FOUNDATION TYPE: I that apply for the new
Early Release ~ Manufactured / construction area)
Permit: Y N Trusses: Y VN
Lot Split: Y V Sump Pump: Y ~. 6 ~~:LSPACE 0 ~~~M&E~~M /
Does any part of the property lie within a special Flood designation area: _Y WALKOUT:_V--0
For Single Family and Drl1 :E18!'0:1~~~~1' , a , 0 accessory structures, this permit is valid only if construction commences
within 180 days of th~m.t 0 l~~~~lwtttu::atJ1lD~\.JijQ~e completed (Certificate of Occupancy issued) within 18 months of the
issuance date. qlass I s~" PCf.~\lltr~~J"''fjeE~E'~' ,,- ~&lI.A, d.ministrativ,C Ru~es of the Stat~ of Indiana (See 675 lAC 12) regarding expiration
. 0 _ .;, ~ ~ tllll<l (l$i~feE.9d completmg constructIOn.
I, the underSIgned, agreeDEfbT c@1;:rQ:G)MJM1~ to, 'a.tg~me..ll~, fFjQcatlon, or alteration of a structure, or any change in the use of land or
structures requested by ~~~i~ wiiKWPRly f1S\:.AlfcQreWN,::It1H'llicable laws of the Stare of Indiana, and the "Zoning Ordinance of Carmel
Indiana - 1993" (Z- 289)WHaTrl~e~~abljf~<r~~r,'Wthority of r.c. 36-7 et seq, General Assembly of the State of Indiana, and all Acts amendatory
thereto. I further certify that orily kitchen, batH,'llJIIIi\*~t~ains are connected to the sanitary sewer. I further certify that the construction will not be
used m~ied until a ertWcl!t~ of~ccupancy has been issued by the Department 0 Community Services, Carmel, Indiana.
e:..u<, ./ ~.U "7~ Tv)'\. 2Dob
Signature of Owner or Authorized Agent Print Date
OFFICEUSEONLY:**************************~******************JJ1~**~~******************
Filing Fees: L.'Zb-. (10
INSPECTIONS REQUIRED: /'
c Base Inspections: h c.. <)() # Charged Re-
(Upper Foo~ Lower Footing Under Slab l . 53 _ ',0 ReViews
Cert. of Occupancy: - ~
~ Meter Base Cfinal S~
c"'o,,;, -.:;..e--
ReviewedjA roved: Dept. of Community Services
S:Permits/Forms/IlP RESIDEfIlTIAl
(Date)
~~.st'~-
Fee Received by: '