HomeMy WebLinkAbout06070189 Application
City O~~~:?TownShip Permit #: ()0070J 9,1-
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, llr. Two Family: New Structures, Additions, Remo
BUILDER of
RECORD:
PROPERTY
OWNER:
LOCATION
llr. PROJECT
INFO:
E~ C
~
STREET ADDRESS I' A -"I 'A . A.I)
r6 5 V\J, V\7U\lta.. ~
BUILDER'S EMAIL ADDRESS
-
Ii
PHONE
D"SL{'5
SEWER UTIl1l}:lA f\ ,^ A -:<7 WATER UTILll)') J _" JA A -r:-7
PROVIDER: ~ V~ t:::: '---- PROVIDER: ~JVYVI..t:!> L-
NAME OF UTILITY EXCAVATION CONTRACTOR; PLAN COMMISSION / BZA / BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'S (IF APPLICABLE):
PE OF. CONSTRUCTION:
SINGLE FAMILY
TOWN HOME
TWO FAMILY
# of units:
o MULTI-FAMILY
# of Units:
o RESIDENTIAL (For
Additions, Remodels, Etc,)
TYPE OF IMPROVEMENT: PLUMBING CONTRACTOR: . ^ _
o NEW STRUCTURE . . /.....-.
o ROOM ADDmON(Slt..Aot~Plumber's Indiana State Licen
o PORCH ADDmON(s1' _
.0 REMODELP.BM~A-71
/"0 ACCESSORY BUILDING Which plumbing codes will be applied to the construction:
o DETACHED GARAGE 0 International Residential Code wjlndiana Amendments
o ATTACHED GARAGE . . .
o DEMOLmON 0 Un,fol1Tl PlumbIng Code w/lndlana Amendments
(Multi-Family Construction Code)
PROJECT INFORMATION: ~ /
Early Release ~anufactured /' FOUNDATION TYPE: (Check all that apply for th/e new
P 't Y N T Y ~ construction area)
erml : russes:
- - - 0 CRAWLSPACE A POST & BEAM
Lot Split: _Y _N Sump Pump: _Y _N 0 SLAB /. 0 BASEMENT
Does any part of the property lie within a special Flood designation area: Y N WALKOUT: Y N
For Single Family and T",o Family dwellings, additions, remodels, and/or acc~.,~mP~~fl ?Bl\'lija~ction commences
. within 180 days of th~-Ftrof,~~,~fJ.h~. ~_uE~.g permit, and must be comp te !H~ te o&b~c~n~,~~~~a)' WitliinI8 months of th~
lSsuanc:,,; date. Class I s~ct.urU'~~~~a~.~~~~ 1:'J ~~~~~~al;Administrative Rules t ~&Gt1-Mi~ (S 'lAC 12) regarding expiratIon
, ill J!r::'-2'::__~'c,-,!:",efiaj]lgf?rbcginningandcWEmi~~UNITY SERVICES
I. the undersIgned, agre~ that,,~y construction, reconstructlOn'tenh\igement, rd~ ~eptlNaf!~truPjtirf, ~~W~~lue of land or
Structures requested by tliiffapplication will comply with, and ~onfOl:In to, all app~dabl~ lM~-ortK2 St:~If~~t1n'di'ah~ahU th~ldrUhk'bM\nance of Carmd
Indiana - 93" (Z'28~) F~ ~~4\\U, a~pt.;d unde; au~?p~?f I,e. 36-7 et seq, General-AssemblylbfU.Bd~f Indiana, and all Act~ amendatory
thereto. er certifyirBatj91,ily kittti'di, ~(an3ffi@9r dr ~~ ~e c;Qnnected.(o.th~anitary sewer~1 further certify that the construco~n ' not be
u c pied n aCdiiFicateofOccupancyhasbeen' edbythe epartmentofComm 'tyServices,Carmel,lndiana. --7 ~-Z
{ - -~ -1"::; I }r ... Nt!> /I ! d7{:J
re of OWner or AuthorizeCl"Agent___o, Prin Date
J
* ** *** ****?,*** **** * **** *******,!!******************
Filin9-Fees: /3'3, J 0
INSPECTIONS REQUIRED: /~ Inspections: 11/. (/ 0 # Charged Re-
Upper Footing Lower Footing Under Slab Reviews
/--- Cert. of Occupancy: :)'3- 5""0
(Ro;;gh In ~eter Base ~ Site PfR.II.F F.: / Additional Fees
"-=- / -7-06 ~f!w ~. 'Ii$ b9&'aO
Reviewed/A proved: Dept.ofCommunitySelVices (Date) ~
S:Permlts/FormsjILP RESIDENTIAL Fee ReceIved by: I
ESTIMATED COST OF CONSTRUCTION: _ ~
(EXCLUDING LAND VALUE) 25{ U'-C-J
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