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CityofCarmel/C/ay Township Permit#: Of;,Of<OOC-,fl)
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, &. Two Family: New Structures, Additions, Remodels, &. Accessory Structures
BUILDER of
RECORD:
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PROPERTY
OWNER:
BUILDER'S EMAIl A RESS
f"lt,~be,~ '@ e5-m.,d ,Nef
NAME
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LOCATION
&. PROJECT
INFO:
SUBDIV)SIO_N NAME}
A-I()('o/n,:;
ADDRESS OF CONSTRUcnO~ /)
/'1.17 CCi,Q/a-z,U /(U/l
WATER lJTIUTY /1 0 (q
PROVIDER: L'c; ~ ;Y) e..
LOHo?3
SEWER lJTIUTY
PROVIDER:
C/o.,
NAME OF LmUTY EXCAVATION CONTRACTOR; PLAN COMMISSION / BZA / BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT ,'S (IF APPLICABLE):
lYPE OF CONSTRUCTION:
~ SINGLE FAMILY
o TOWN HOME
o TWO FAMILY
# of units:
o MULTI-FAMILY
# of Units:
o RESIDENTIAL (For
Additions, Remodels, Etc,)
lYPE OF IMPROVEMENT:
(gl' NEW STRUCTURE
o ROOM AOOmON(S)
o PORCH ADDITION(S)
o REMODEL
o ACCESSORY BUILDING
o DETACHED GARAGE
o ATTACHED GARAGE
o DEMOLITION
cm
STATE
IN
BEST METHOD OF CONTACT:
jJlJo--rv-
PHONE
FAX
cm
J r.:....-=::---STAT~_ ZIP
,In @: cg ~ ~i5'-
In -zo~m5-J
U 55)5
OOS''l
ESTIMATED COST OF CONSTRUCTION:
(EXCLUDI UE
,~'
0)/8/000
ele~71/
PLUMBING CONTRACTOR: j.
-<-J) />1ec /)c{/V}IC'c...
Plumber's Indiana State License #:
It 8;OG;,L/5L/O
Which plumbing codes will be applied to the construction:
fJi! International Residential Code wjlndiana Amendments
o Uniform Plumbing Code wI Indiana Amendments
(Multi'Family Construction Code)
PROJECT INFORMATION:
E I R I M f ct d FOUNDATION lYPE: (Check all that apply for the new
ar y e ease anu a ure E .
P 't Y N T Y N construct.on area)
erml : russes:
- \!J ~ - 0 CRAWLSPACE 0 POST & BEAM
Lot Split: _Y ---r-filELE.l-\~~5u~8: ~_N 0 SLAB iF' BASEMENT
Doesanypartoftheprop~I~l"!!!~8rfl ,,;,}.la bUT~~~area: _Y ~N WALKOUT:_yLN
For Single Family and Two Family"dwelfhfJl.t{H3iil6ni,i.:auml~&r accessory structures, this permit is valid only if construction commences
within 180 days of the date ofQ.blttiTe e au(}@i~P..2Mtr,'Vlcb1!~~~leted (Certificate of Occupancy issued) within 18 months of the
issuance date. Class I structu~pptne rJ~s,q.pffitjp..~~e (:;A~~I~a1 !d.;nlrli~t~':rt:~ul.es of the Stat~ of Indiana (See 675 lAC 12) regarding expiration
v'1rilltYn;~~ ~nifi~W~lng construction.
1, the undersigned, agree that any construction, reco*t@.~nlargl'ment: relocation, or alteration of a structure, or any change in the use of land or
structures requested by this application '\vill comply with, and corlorm to, all applicable laws of the State of Indiana, and the "Zoning Ordinance of Carmel
lndiana - 1993" (Z- 289) and amendments, adopted under authority of r.c. 36-7 et seq, General Assembly of the State of Indiana, and all Acts amendatory
thereto, 1 further certify that only kitchen, bath, and floor drains are connected to the sanitary sewer. I further certify that the construction will not be
used occupied until a erei/ic8e' f Occupancy has been issued by th Departme >r Community Services. Carmel, Indiana.
C; ;,0e,€ 8- 8 -aD
Print Date
* ***************************
Filing Fees:
Base Inspections:
Cert, of Occupancy:
,,;
P,R,J.F,:
OF
lab
***********************
riff} _ <;'0
;) '7 '2 $"0
S-3.5(}
CO
. T 3 d. S-O
# Charged Re'
Reviews
I
Additional Fees
T~~~
,
ReviewedjAppr ed: Dept. of Community Services
S;Permlts/Fom1S/ILP RESIDENTIAL