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City of Carmel/Clay Township Permit #: O&O'i<OO~G
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, &. Two Family: New Structures, Additions, Remodels, &. Accessory Structures
BUILDER of
RECORD:
PROPERTY
OWNER:
LOCATION
&. PROJECT
INFO:
NAME A
WC>if~
CvV5f~cl. rJ
PHONE
FAX
S-.f';
5~7 Y~I
CITY
2-, DfilSJJ I
NAME
W.5>OV~
STREET ADDRESS
SEWER lJTlUTY
PROVIDER: C1- r I!- w 1)
STA
ZIP
IS 0 7'/
PHONE
FAX
cm
STATE
ZIP
,'D
I' SIerraN
(3 ucl<.- e-
5"'D/-
ESTIMATED COST OF CONSTRUcnON:
(EXCLUDING LAND VALUE) /.. '1
NAME OF UTILITY EXCAVATION CONTRACTOR; PLAN COMMISSION I aZA I BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY WElL AND/OR SEPTIC PERMIT #'5 (IF APPLICABLE)=C- - --
TYPE qF CONSTRUCTION:
Cf'J" SINGLE FAMILY
o TOWN HOME
o TWO FAMILY
# of units:
o MULTI-FAMILY
# of Units:
o RESIDENTIAL (For
Additions, Remodels, Etc.)
PROJECT INFORMATION: /
FOUNDATION TYPE:
Early Release _Y v"N Manufactured co~stru 'on area)
Permit: Trusses: _y:. N
Lot Split: _ Y ('" N Sump Pump: ~ Y _N 0 ~~:LSPACE
Does any part of the property lie within a special Flood designation area: _ Y t./N
TYPE OF IMPROVEMENT:
o NEW STRUCTURE
o ROOM ADDITlON(S)
o PORCH ADDITION(S)
o REMODEL
o ACCESSORY BUILDING
o DETACHED GARAGE
o ATTACHED GARAGE
o DEMOLITION
PLUMBIN CO RACTOR: I'" "I' ili
() I 'In' .1,,,, " :1 I"
A,,,- ..J.c..A:<;&1 1,1 i4......~ 2006 :iI il!
Plumber's Indiana State License #: ,I L; / i
C D ~ v a I ~,l--'-- J L-/ I
V. D J LnDry K,'c> I
Which plumbing codes will be applted-w the eonstructfon:~____"
o International Residential Code wI Indiana Amendments
~rm Plumbing Code wi Indiana Amendments
(Multi-Family Construction Code)
(Check all that apply for the new
o POST & BEAM
~ BASEMENT
WALKOUT:_Y _N
For Single Family and Two Family dwellings, 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 If'^.. lri.in.S.. .arl~i. ~..' ~x):~::~n~~~:~:p~e~\:~ o:o~s:~~:~~f Indiana (See 675 lAC 12) regarding expiration
I, the undersigned, agf~~&fY' ~,~tI!lSiiI9b,f~'~9W;;~~m,~,; ~ii~~ent, relocation, or alteration of a structure, or any change in the USe of land or
structures requested by dhs applica'(jon will comply ...virh, and conform to, all appbc<lbJe laws of the State of Indiana, and the "Zoning Ordinance of Carmel
Indiana -1993" (Z~289) and amendments, adopted under authority of J.c. 36-7 et seq, General Assembly of the State of Indiana, and all Acts amendatory
thereto. I further certify that only kitchen, bath, and floonlntrrs-aF connected to the sanitary sewer. I further certify that the construction will not be
UD ded until a Cerejfjcate of occu/ncy'h'a> been issued the Department of Community Services, Carmel, Indiaua. '/ b /6 {
'0/.. I
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Filing Fees: / ~ 3c... rJ
,
:J,-71, ,)0
0]. i<)t)
!:2-bIOO
v
r r<71 ~"Htt-Lr g-I-66
Reviewed/Approve~: Dept. 0 Community Services (Date)
S:PermitsjFormsjILP RESIDENTIAL
Fee Received by:
# Charged Re-
Reviews
Additional Fees
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