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City of Carmell Clay Township Permit #:(>~D7 tJ I R 3
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, &. Two Family: New Structures, Additions, Remodels, &. Accessory Structures
ADDRESS OF CONSTRUCTION
91 '3.;7
SEWER lJTlUTY
PROVIDER: -r w D P VlDER: Co.." I"\i\.
NAME OF lfTILfTY EXCAVATION CONTRAcroR(~ ,-', ION I BZA / BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNJ'I-wEtl:' S C PERMIT #'5 (IF APPLICABLE):
c:--....\l. v '\
TYPE OF CONSTRUCTIOp.~?'0
~INGLE FAMILV~
o TOWN H~OM~~ <(, ~
o TWO FA ~ '\.
# of uni " ~\,
o MUL TI-FAM
# of Units:
o RESIDENTIAL (
Additions, Remod
BUILDER of
RECORD:
PROPERTY
OWNER:
LOCATION
&. PROJECT
INFO:
INF
STREET ADDRESS
'(p fR f.,
,eS
fZ /7 'f4 Sf-
PHONE
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Is
LOT #
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ZIP
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CITY
BEST METHOD OF CONTACT:
<:miD
FAX
,)-'i:l(.,f'
I7STATE t/ t,..;JS;
c.. Com
PHONE -u--
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ZONING:
S-I
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7 S. eoc,
1)u.-14-c "-M.O.\Jl>-\>I'\'~ 0
PLUMBING CONTRACTOR: 10J11Y)(L
~~ 0~mb
Plumber's Indiana State license #: ~
rlb?bO::>'1
ESTIMATED COST OF CONSTRUcn
(EXCLUDING LAND VALUE)
Whi~lumbing codes will be applied to the construction;
WIntemational Residential Code w IIndiana Amendments
o Uniform Plumbing Code w/lndiana Amendments
(Multi-Family Construction Code)
FOUNDATION TYPE: (Check all that apply for the new
construction area)
/' Manufactured /'
Y V N Trusses: ...':::::. Y _N
- v-:. 0 CRAWLSPACE
Lot Split: _Y _N Sump Pump: _Y _N 0 SLAB /'
Does any part of the property lie within a special Flood designation area: _ Y ~
Early Release
Permit:
o EOST & BEAM
(1Y""BASEMENT
WALKOLrT:_Y _N
For Single Fa~~ and Two Fami~2.~llin~. additioq.si~.IDp.4eh, and/or accessory structures, this permit is valid only if construction commences
within 180 da'HEitlt.titASEiID.s~ 'it UiNSmM\aldiUlWd must be completed (Certificate of Occupancy issued) within IS months orehe
issuance date. ~ble~~eSHmlqc~J:P~~etmn~dministrativc Rules of the State of Indiana (See 675 lAC 12) regarding expiration
. ". of State and Locaire-d~ for beginning and co~pJcting con~truction. .
t, the underslgne~e diat an):...c~n~r.I}l~~19[1,f~Jl~AQl}.~Jl&mcm, relocatIOn, or alteration of a structure, or any change In the use of land or
structures reques thi~~plylw~~ to, all applicable laws of the State of Indiana, and the "Zoning Ordinance of Carmel
Indiana -199r~)(ilWi~~E~ d ltdq-fllWNSfftP 36-7 et seq, General Assembly of the State of Indiana, and all Acts amendatory
thereto. 1 further cemfy'(1;at on1y'kH:~q~rw ' 'noar drains are connected to the sanitary sewer. I further certify that the construction will not be
used or oc~upied until a CertilicateH/ltllJ has been issued by the Depactment of Community Services, Cacmcl, Indiana. !. ~
0~~o..o~v.. ~~VCI~V' 7~ 4~
Signature of Own r Authorized Agent Prin Date
OFFICEUSEONLY:******************************************************~~****************
Filing Fees: -3y.~ 5(J
INSPECTIONS RE UIRED: -'77. -{} # Charged Re-
Base Inspections: / ,.::>
Reviews
Cert of Occupancy: s- 3- S'{}
C , (j()
~~%~
pper Footing
c
Lower Footing
ab
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Meter Base
Final
Site
P,R,LF,:
I
Reviewed/Approv ept. of Community Services
S:Permits/forms/ILP RE$IOENTlAL
Additional Fees