HomeMy WebLinkAbout06060105 Application
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City of Carmel/Clay Township Permit #: Ob<J0 rJlOS
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, &. Two Family: New Structures, Additions, Remode/s, &. Accessory Structures
BUILDER of
RECORD:
NAME ~' n
~i f!I! S V_Q....(/ +'L<!:>I
STREET ADDI)ESS
'7l.fro 7 /at, u J)/C
PHONE
~pc.,
17
7-i-o'i9 y
FAX
~~ 'is -cJ'79
BUILDER'S EMAIL ADDRESS
'KDS 2-L-.Q)'/dL.G IV\..
CITY STATE
r~~-__.:::r-/Vdf;s_ ...J>V
! ; {1 I ,~::.;.' (;:'-~;~sr;METHOQ OF CONTACT:
i'l I ~~., 'l ,I', '/1" ---
i; u ~-':.:0:.'$ Li \ ,l7'jlr---, q (. -
PHONE 11 FAX
I
ZIP
'Tt.27/
~55"(
LOCATION
&. PROJECT
INFO:
LOT #
SUBDIVISION NAME
5[, loour,n/(. /:;sk
ZIP
PROPERTY
OWNER:
NAME
STREET ADDRESS
WATER UTILIl)'-,
PROVIDER: U
ZONI G: -:5....\
eSI{UJf.J^ '-
SQUARE
FOOTAGE: 0'-/ '-f
ADDRESS OF CONSTRUCTION
SEWER LfTIlrrY \ .., ,
PROVIDER: C I- -rVJ
ESTIMATED COST OF CONSTRUcnON:
(EXCLUDING LAND VALUE) 3 S 5 0.0> =
NAME OF UTIUTY EXCAVATION CONTRACTOR; PlAN COMMISSION j BZA I BPW DOCKET 11
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'S (IF APPLICABLE): rr - I <;;uf.L r.~r ueu ,"'. I-",,,:!:.
TYPE OF CONSTRUCTION: TYPE OF IMPROVEMENT: PLUMBING CONTRACTOR:
d\. SINGLE FAMILY rj( NEW STRUCTURE 5 !+ Pc t+ Ilr rJ
o TOWN HOME 0 ROOM ADDITION(S) Plumber's Indiana State License #:
o TWO FAMILY 0 PORCH ADDITION(S) /If <) I D (, <.1" I Q
# of units: v/),... I
o REMODEL
o MULTI-FAMILY 0 ACCESSORY BUILDING
# of Units: 0 DETACHED GARAGE
o RESIDENTIAL (For 0 ATTACHED GARAGE
Additions, Remodels, Etc.) 0 DEMOLITION
Which plumbing codes will be applied to the construction:
r$J....lnternational Residential Code w/lndiana Amendments
o Uniform Plumbing Code wI Indiana Amendments
(MUlti-Family Construction Code)
PROJECT INFORMATION:
Early Release
Permit:
_Y_N
Manufactured
Trusses:
FOUNDATION TYPE: (Check all that apply for the new
construction area)
_Y LN
o CRAWLSPACE
Lot Split: _Y -AN Sump Pump: Ly _N 0 SLAB
Does any part of the property lie within a special Flood designation area: _Y IN
o POST & BEAM
Cji( BASEMENT
WALKOur:_ Y-L..N
For Single Family and Two Family dwellings. additions, remodels, and/or accessory structures, this permit is valid only if construction commences
. within 180 c:f.!Etf1:d:Jt;~fP@:Ac():(!)::N.$iJiRti(}Trt:QN.nd must be completed (Certificate of Occupancy issued) within 18 months or the
lssuan,c~ dilte. k~~JJfl~~f8l)FrllSrm~~~\Y'i~R!mUUtIfIbif.1(lfM~.Ad.ministrative Ru~es of the Stat~ of Indiana (See 675 lAC 12) regarding expiration
'. . JI . ~e ra~'f;s1oroegmmng and completmg constructIon.
I. the urid~rsi~~d, agre. eQf~~~H1~~~b ~Ction.~~argement, relocation, or alteration of a structure, or any. change in the use of land or
structures requti-8i)rd@fiPo.QMM.UJ~~ &.EDR\6till1&; to, all applicable laws of the State of Indiana, and the ~Zoning Ordinance of Carmel
Indiana -199.}:.~j!U.i~4..Jj\~is, j.4eilt~~ufi;j:,. 36~7 et seq, General Assembly of the State of IndIana, and all Acts amendatory
thereto. I furMb!t!f1fh~m~!b~a fl~~ Jr\fjl1~elttmnected to the sanitary sewer. I further certify that the construction will not be
used or occu i until a Ci rtjfica~Acy has been issued by the Department of Community Services, Carmel, Indiana.
"
,,?~g- Sil"'5 &/1 s/a (.
Signature of Owner or Authorized Agent
Print
Date
Site
,
('~~~ J-t/V--r r;,~JC1l4
ReviewedjAppr ed: Dept. of Community Services (Date)
S:Permits{forms/ILP RESIDENTIAL