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City of Carmel/Clay Township Permit #: Ob07DDD~
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, &. Two Family: New Structures, Additions, Remodels, &. Accessory Structures
BUILDER of
RECORD:
. \ r- PHONE
Of""t=' 1 . :;J.t.. - Jf 5 05
cm {ST~TE
~6G1\J.C'ud.&.. 10
BEST METHOD OF CONTACT:
PROPERTY
OWNER:
NAME
C"I\INIG '5WA-4"
#lL,c?OJ,
PHONE
FAX
SEWER UTILITY
PROVIDER:
LOT # ~SUBDIVISION ~AME
17~ sJ, Orl")e.
ADDRESS OF CONSTRUCTION
3 S'-t (,
C:ia
SECTlON
STREET ADDRESS
54~ IN II,
On
cm
GL-
LOCATION
&. PROJECT
INFO:
Ek~ 8LVCl
C\ll~/;;;
SQUARE
FOOTAGE:
l}
WATER UTILITY / _ .
ROVIDER: .r hd -) l.fl.Trn ej
ESTIMATED COST OF CONSTRumON:
(EXCLUDING LAND VALUE)
NAME OF UTILITY EXCAVA ON CONTRACTOR; PLAN COMMISSION I BZA / PW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'5 (IF APPUCABLE):
Gj) 1'4.
PROJECT INFORMATION:
Early Release Manufactured / FOUNDATION TYPE: (Check all that apply for the new
. /' 0/ construction area)
Permit: _Y ~N Trusses: Y - N
. Y 7::.N 0 CRAWLSPACE
Lot Split: _Y VN Sump Pump: ~ SLAB
Does any part of the property lie within a special Flood designation area: _ Y l(...N
TYPE OF CONSTRUCTION:
o SINGLE FAMILY
o TOWN HOME
o TWO FAMILY
# of units:
o MULTI-FAMILY
# of Units:
RESIDENTIAL (For
Additions, Remodels, Etc.)
TYPE OF IMPROVEMENT:
o NEW STRUCTURE
o ROOM ADDITION(S)
$. PORCH ADDITION(S)
o REMODEL
o ACCESSORY BUILDING
o DETACHED GARAGE
o ATTACHED GARAGE
o DEMOUTION
Which plumbing codes will be
o International Residenti
o POST & BEAM
o BASEMENT
WALKOUT:_Y_N
For Single Fa~~!~~~NStTt ,e 9 els, a'nd/or accessory structures, this permit is valid only if construction commences
within 180 da e ate fBf a~ Wi.tht:E1P&~~1P'9ff'd must be completed (Certificate of Occupancy issued) within 18 months of the
issuance date. ~ '~e ~~ml~~a['O'C'81'1S'dG. Genetal Administrative Rules of the State of Indian.JIS 675 lAC 12) regarding expiration
of'St ea ~~ningandComPletin Co ~'m\
I, the undersign ~l@JIin~M-MJJ~le\:dnMfial'ol1.1 e !JlQ. - hange in the use of land or
strUctures reque~~' .. . fl~~itl,. itr - . c. . ana, and the ""Zoning Ordinance of Carmel
Incliana-199r01JsY) ~~~o underauthorityofLC. ,t., n r, Assembly of the State of Indiana, and all Acts amendatory
thereto. 1 further certify that only'kitc~'t1 ~ floor drains are connected to the sanitary sewer. I further certify that the construction will not be
or occupied until a Certific e f Occupancy has been issued by the Department of Community Services, Carmel, Indiana.
:) A-mlTs /nSU) hDr/-e.J
Print
o!/os/o(P
OFFICEU5EONLY:**********************************************??*******~****************
Filing Fees: /1-20, 3,F
INSPECTIONS REQUIRED: '
~ Base Inspections: .;J d.-~ 00 # Charged Re-
~per FootinVLower Footin!!('Under Sla -- Reviews
Cert.ofOccupancy: C~- 5'0
iRo~ Meter Base ~ Site
~ l.7 P.R.I.F.:
c
I
ReviewedjAp oved: Dept. of Community Services
S:PermitsfFormsfIlP RESIDENTIAL.
(Date)
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