HomeMy WebLinkAbout06070059 Application
BUILDER of
RECORD:
City ofCormel/Gay Township Wi ~ ' "'m' .()b()70D5'j
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, & T~..F.am~YI~ ~~ Structures, Additions, Remodels, & Accessory Structures
c.111L~^ .LI1!t.15
Shannon Hi, ,) rfflj'NE FAX
NAME
PROPERTY
OWNER:
c
STREET ADDRESS
STATE
ZIP
FAX
F N R CTI N:
SINGLE FAMILY
TOWN HOME
o TWO FAMILY
# of units:
o MULTI-FAMILY
# of Units:
o RESIDENTIAL (For
Additions, Remodels, Etc.)
CITY
STATE
ZIP
LOCATION
& PROJECT
INFO:
LOT #
ZONING: 5 --- t.
SQUARE
FOOTAGE:
SEWER UTILITY/) Af11 1-..
PROVIDER: u~ I
NAME OF lfTILIlY EXCAVATION CONTRACTOR; PLAN COMMISSION')'SZA I BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTICPERMIT #'5 (IF APPLICABLE):
TYPE OF IMPROVEMENT:
g
o
o
o
o
o
o
NEW STRUCTURE
ROOM ADDITION(S)
PORCH ADDITION(S)
REMODEL
ACCESSORY BUILDING
DETACHED GARAGE
ATTACHED GARAGE
DEMOLITION
PROJECT INFORMATION:
Early Release
Permit:
FOUNDATION TYPE: (Check all that apply for the new
construction area)
Manufactured
_Y lN Trusses: lY_N
o CRAWLSPACE 0
Lot Split: _ Y LN Sump Pump: - Y --.2LN R SLAB t../' 0
Does any part of the property lie within a special Flood designation area: _ Y _N
POST & BEAM
BASEMENT /
WALKOUT:_Y~
For Single Family and Two Family dwelli!lgs, additions, remodels, and/or accessory structures, this permit is valid only if construction commences
within 180 days of the date of issuance of the building permit, and must be completed (Certificate 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
use or occupied until Ce ~jficate o{Occupan(.y has been issued by the Department of C:mmunity Services, Carmel, Indiana. ...7
r- t ~1-!j)JJ~It2AI flI/J.JHIl /AI lY- /:J.-tJu
Slg ture f OWner r Authori ed Ag nt Print Date
OFFICE USE ONLY: ********************************************.f' *
Filing Fees: '
'- T~ECTIONS REQUIRED: " -"7 ---: ~O
.r-- r-- . --...... Base Inspections: ~ L J, v
'-.Upper Foo . Lower Footing 'Yo.ller Slab J 53 :)'0
~ Celt. of Occupancy: .. _
Cough .--~tc, B"';A Site /', I { () 0 . .
- -JL ~ ~~i:-3"1b-;O"-
Reviewed/Approved: Dept. of Community Se (Date) -
S:Permits/FormsfllP RESIDENTIAL
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# Charged Re-
Reviews
Fee Received by: