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City ofCarmeIlClay Township Permit #: (X,O'9,f1Qc&Lf
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, & Two Family: New Structures, Additions, Remodels, & Accessory Structures
BUILDER of
RECORD:
FPCJ.
616-CJ.3/o
E
PROPERTY
OWNER:
PHONE
FPCJ.
STREET ADDRESS
CITY
STATE
ZIP
LOCATION
& PROJECT
INFO:
TYPE OF CONSTRUCTION:
err-SINGLE FAMILY
o TOWN HOME
o TWO FAMILY
# of units:
o MULTI-FAMILY
# of Units:
o RESIDENTIAL (For
Additions, Remodels, Etc.)
'\ I SQUARE \'\ 'j' i. n-:' I '"~''-'-''' j
O 00 i ! i -FOOTA6E:.~'~1 ill i i
o . I I \_..A./v. ' I 1,
ESTIMATED COST OF!coils\-RuCTIO~ J II )11
(EXCLUDING LAND ~~7U~)i ! AIJW J d i
:.'J II i I Ll/
NAME OF UTILITY E CAVATI ONTRACTOR: PLAN COMMISSION / BZA / BPW DOCKET 0 _/ ). W L_ L-/
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'5 (IF APPLICABLE): J-- II
PLUMBING CONTRACTOR.
J-kvY)YYl CJ: ~n<=:; .l.n c:.......
Plumber's Indiana State License #:
a.....P I c::Y.)(')O / n /
.
TYPE OF IMPROVEMENT:
Q--m:w STRUCTURE
'0 ROOM ADDITION(S)
o PORCH ADDITION(S)
o REMODEL
o ACCESSORY BUILDING
o DETACHED GAP' -
o ATTACHED Gf
o DEMOLITION
Which plumbing codes will be applied to the construction:
lst. ~Itll:mational Residential Code w/lndiana Amendments
o Uniform Plumbing Code wi Indiana Amendments
(Multi-Family Construction Code)
PROJECT INFORMATION:
Q D FOUNDATION TYPE: (Check all that apply for the new
EparlY.Release Y TManufactured construction area) rC;"~,~j, -)
ermlt: russes: N '-1" vll'CP
- A.'\ /:'\ 0 CRAWLSPACE 0 POST & BEAM~""'~.'d_rJ.
lot Split: _ Y ---f:Y Sump Pump: ~N 0 SLAB &.. BASEMENT )!;Gmt- W '0'(1'1
Does any part of t~e:p':operty lie within a special Flood designation area: _ Y ~ WALKOUT:_ Y
For Single Family an~iAn9,SQ,JftQfa <OO:NS,T~~r accessory structures, this permit is valid only if construction commences
within 180 days of t~ f~~~B~Wf-tfflarfrroiA;1 Mf.I.jPm~ be completed (Certificate of Occupancy issued) within 18 months of the
issuance date. Class I structureQjfJS.Hifd'rar~(ljbLeclb~ t;A~~lf,p,J!r'i1?\a:-niinistrative Ru~es of the Stat~ of Indiana (See 675 lAC 12) regarding expiration
tIme rraM~~&"b~g~~~ll.and completmg constructIOn.
I, the undersigned, agrQffiR~pEh~~'JU{tiSffiM~ relocation, or alteration of a structure, or any change in the use of land or
structures requested etl1Ya@fK:c@:A~p eitln:v-d:rcI'vi~'IQIts!~IeJ'plicable laws of the State of Indiana, and the "Zoning Ordinance of Carmel
Indiana -1993" (Z~289) and amendments, a \lW1U(hb~yJr~~~~t et seq, General Assembly of the State of Indiana, and all Acts amendatory
thereto. I further certify that only kitchen, , N& drains are connected t'o the sanitary sewer. I further certify that the construction will not be
or occupied until a Certificate of Occupancy has been is' the Department of Community Services, Carmel, Indiana.
- .
713'/ Io~
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OFFICE USE ONLY: ************************************************************************
Filing Fees: 9;2..;;""', /0
INSPECTIONS REQUIRED: . 7 ,-r7 "'-(r
_ Base Inspections: _ / t2- ..> ,
(!lpper FootinVLower Footi~ Under Slab 0 5].) Cl
~ Celt. of Occupancy:
~ ~eterge Final . Sit
~ P.R.LF.:
.
C '('0..;0.. H/~~ ?:"'Z-Gb
Reviewed!Appro~ed: Dept. of Community Services (Date)
S;!>ermitsjForms/ILP RESIDENTIAL
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Reviews
Additional Fees