HomeMy WebLinkAbout04120023 Application
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City of Carmel/Clay Township \)J ~ Permit#: fol-UD~
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, & Two Family: New Structures, Additions, Remodels, & Accessory Structures
SEWER lITILITY
PROVIDER:
ADDRESS OF CONSTRUCTION a 5l.P 5
^ WATER lITIlfTY ~ " _ La
vQ;(f(\e: PROVIDER:' t'T W()..:1U
FAX
8-I2.-8~ II:...(>
BUILDER of
RECORD:
STATE ZIP
~l.oQ
BUILDER'S EMAIL ADDRESS
PROPERTY
OWNER:
NAME
FAX
sr3JJ
ZIP L/6 IJ 32
ZONING: S-I
SQUARE
FOOTAGE: I'OW
UCTION: I \ P; I 'OeD
LOCATION
& PROJECT
INFO:
LOT #
NAME OF lITILITY EXCAVATION CONTRACTOR; PLAN COMMISSION / BZA / BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'S (IF APPUCABLE):
OF CON UCTlON:
SINGLE FAMILY
TOWN HOME
o TWO FAMILY
# of units:
o MULTI-FAMILY
# of Units:
o RESIDENTIAL (For
Additions, Remodels, Etc.)
PROJECT INFORMATION:
Early Release / Manufactured
Permit: Y L-J! Trusses:
Lot Split: _Y LN Sump Pump:
Does any part of the property lie within a special Flood designatio",B
_y~
_vA
_Y_N
For Single Family and Two Family dwellings, additions, remodels, and/or ace sory structures, this ^ valid only if construction commences
within 180 days of the date of issuance of the building permit. and must be com caee of Occupancy issued) within 18 months of the
issuance date. Class I structure permits are subject to the General Administrative Rules of the State of Indiana (See 675 lAC 12) regarding expiration
time frames for beginning and completing construction.
I, the undersigned, agree that any construction, reconstruction, enlargement, relocation, or alteration of a structure, or any change in the use of land or
structures requested by this application will comply with, and conform to, all applicable laws of the State of Indiana, and the "Zoning Ordinance of Carmel
Indiana -1993" (Z,289) and amendments, adopted under authority of LC. 36~7 et seq, General Assembly of the State of Indiana, and all Acts amendatory
thereto. I further certify that only kitchen, bath, and floor drains are connected to the sanitary sewer. I further certify that the construction will not be
us or occupied until Certificate of Occupancy has been issued by the Department of Community Services, Carmel, Indiana.
, \Dn", CDmcJI \lAo-OL\
Print <J Date
OFFICEUSEONLY:********************************************)***************************
Filing Fees: _ ;t,,,> I 0 ()
NSPECTlONS REQUIRED: / r"1 I 0 0 # Charged Re-
Base Inspections: _;"L~ _
Lower Footing Under Slab k- f) ReVlews
Cert. of Occupancy: , -) 0, () _
TOTAL: $'331. [) editiOnal F7
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Fee Received b '-' I
Final
P.R.I.F.:
Reviewed/Approved: ept. of Ccimmunity Services
S:PermIts/FonnS/!LP RESIDENTIAL