HomeMy WebLinkAbout06050220 Application
City of Carmel! Clay Township ~rmit #: t:Xe 1:) 50 2~Q
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, &. Two Family: New Structures, Additions, Remodels, &. Accessory Structures
BUILDER of
RECORD:
PROPERTY
OWNER:
LOCATION
&. PROJECT
INFO:
SEWER LfTIL
PROVIDER:
NAME OF UTIUTY EXCAVATION CONTRACTOR; PLAN COMMISSION / BZA I BPW DOCKET
NUMBERS: TAC DATE(S); ANDIOR COUN1Y WELL ANDIOR SEPTIC PERMIT #'S (IF APPLICABLE):
TYPE OF CONSTRUCTION~: TYPE
~o SINGLE FAMILY ~
TOWN HOME Il: 0
TWO FAMILY 'J ~ 0
# of units: 0
o MULTI-FAMILY 0
# of Units: 0
o RESIDENTIAL (For 0
Additions, Remodels, Etc.) 0
F IMPROVEMENT:
NEW STRUCTURE
ROOM ADDITION(S)
PORCH ADDITION(S)
REMODEL
ACCESSORY BUILDING
DETACHED GARAGE
ATTACHED GARAGE
DEMOLITION
FAX
\1( lO~lY
ZON~I
SQUARE
FOOTAGE"
~
,
,
,
,
PROJECT INFORMATION:
Early Release "il Manufactured
Permit: _Y 2\S,..N Trusses: ~Y_N
Lot Split: _Y RN Sump Pump: .2l:-Y_N
Does any part of the property lie within a special Flood designatio, --MA I'L, _ Y N
FOrSingleFam'A~AS6eilf'~1 " . i s,re and/oraccessor sri tures,thispermiti"svalido Uf~1nstructioncommences
within 180 daY~Rl ~ fu~1'O e8M~twnof:dttimia:l\neFlH- ,an must be comp,leted .. t.-e-af...ckcu.pa.nq'..i~u )'v.pthin 18 months of the
issuance da"te. Cf.lM ructf~t%,'~~c.Pt.~f~orlaSGcneral AdministrativeLRules of the State of Indiana (See 675 IACj12) regarding expiration
o p\,I1YfSeRf;tM&ing and com~iI.g een"metioo J
I, the underSignel~1h(t).fn~bt\, f~consFW. .~QQ"h.~&t1Jll1t, relocation, or alteration of a structure, or anr diange In [he use of land or
structures reque~ t~~,. ~ 1>G:t!AYthf 1ikV~!nlttJ, qll applicable Jaws of the State of Indiana, and the "Zoning Ordinance of Carmel
Indiana -199Y (k"I 9 ahfiram n m ,14~-,,[~qA.nder authority of LC. 36~7 et seq, General Assembly of the State of Indiana, and all Acts amendatory
thereto. I further certify that only..kitc ,~~l~a floor drains are connected to the sanitary sewer. I further certify that the construction will not be
used o~~d until a Certincate of Occupancy has been issu:d by the Depat.tment of Community Services. Catmel, Indiana.
(--Up\- ('YJ.dE':rGLL- ICJt2\ lfti\'klGI\ 5ldLjIn~
Signature of OWner or Authorized Agent < Print Date
OFFICEUSEONLY:**********************************************~************************
Filing Fees: l./b g f~
INSPECTIONS REQUIRED: · _
Base Inspections: 'J... " # Charged Re-
O ReViews
Cert, of Occupancy: ..5:3 , ~
j;Z(oA .. 00
Site
P.R.I.F.:
Additional Fees