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City of Carmel/ Clay Township Permit #: 0((>02> 001 'd-
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Town Home, 8< Two Family: New Structures, Additions, Remodels, 8< Accessory Structures
BUILDER
OF
RECORD:
PROPERTY
OWNER:
LOCATION
8< PROJECT
INFO:
SEWER UTIliTY
PROVIDER:
NAME:
-1ARI), r,J c....
PHONE:
(311 443- /483
STREET ADDRESS:
~2... 5 00
BUILDER'S EMAIL ADDRESS: (~
""'0 /e-e i"'-MOTIOI'\. "'~
NAME:
L..AAA
STREET ADDRESS:
3:2-3
LOT #:
CITY:
€5-row~
STATE:
;IjJ
ZIP:
4t,47
BEST METHOD OF CONTACT:
FifoiJe
PHONE:
FAX:
~L.".:TCj./ ".~
CITY: STATE: 4:~33
eL.. rtJ
SECTION: ZONING:
";"033 SQUARE J-34
6L :Lk) FOOTAGE:
ESTIMATED COST OF CONSTRUcnON; 1
(EXCLUDING LAND VALUE) 2.5 000. ..6
SUBDIVISION NAME:
NAME OF UTILITY EXCAVATION CONTRACTOR; PLAN COMMISSION / BZA I BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'S (IF APPUCABLE):
FLOOD ZONE AREA DESIGNATlON(S)
FOR THIS PROPERTY:
TYPE OF CONSTRU
o SINGLE FAMILY
o TOWN HOME
o TWO FAMIL
# of units bein
constructed at this
time:
~ RESIDENTIAL(For
Additions. Remodels. Etc.)
PROJECT INFORMATION:
Early Release
Permit:
Lot Split:
_V_N
_V_N
'f.
~At>~
VA~ f<oSE. ~Q\
TAX MAP PARCEL.#:~ ~ \ "'if ~.. \\'\'
\rr @,~ \
PLUMBING CONTRACTO~! 1)6 \
\\\ t>.UG-22.1l
Plumber's Indiana State Li~t'"t :
TYPE OF IMPROVEMENT:
o NEW STRUCTURE
~ ROOM ADDITION(S)
o PORCH ADDmON(S)
o DECK ADDmON(S)
o REMODEL
_ Basement Finish only
o ACCESSORY BUILDING
o DETACHED GARAGE
o ATTACHED GARAGE
o DEMOLITION
Which plumbing codes will be a plied to t
dion:
o International Residential Code wI Indiana Amendments
o
Uniform Plumbing Code wI Indiana Amendments
FOUNDATION TYPE: (Check all that apply for the new
construction area)
Manufactured
Trusses:
Sump Pump:
_VlN
LV_N
~ CRAWLSPACE
o
o POST&
BEAM _PIER
SLAB
o BASEMENT (WALKOUT:_ V _N )
For Single Family and Two Family dwellings, additions, remodels, and/or accessory structures, this pennit 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 underSigne~, a ree at ~_. _~. . gement, relocation, or alteration of a Structure, or any change in the use of land or structures
requested by this . . ..t; ci "., '_ icable laws of the State of Indiana, and the "Zoning Ordinance of Carmel Indiana - 1993" (Z-
289) and amendm. .' .'. r ," 6 e q, eneral Assembly of the State of Indiana, and all Acts amendatory thereto. I further certify that only
kitchen, bath, and r drams are connected to the sanitary sewer. I further certify that the construction will not be used or occupied until a Cerniicate of
Occupancy has been issued by the Department of Community Services, Cannel, Indiana.
- RDD€'RIc.J/.. .::r JoG~L.t:.
Print
Signa
OFFICEUSEONLY:*****************************************************~***************************
SPECTIONS REQUIRED: Filing Fees: lib / ~J:
. . Base Inspections: /6 ( -> 0 # Charged Re-
pper Foot, Lower Footing Under Slab . Reviews
S Cert. of Occupancy: :; -5. )U
Meter Base Final Site
P.R.I.F.: Additional Fees
Cvn'l~ f(J;~ 8-4-06 TOTAL: %38/. s?
Rev,ewed/Appr ved: Dept. of Community Services (Date) ~ e..u-. g / II /~
S:Permits/FormS/IlP RESIDENTIAL F Receive : C{9-'"'A. , / Date
0/z./D~
Date r