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City ofCarme/lClay Township Permit #: oreo~OO(, S--
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Town Home, 8< Two Family: New Structures, Additions, Remodels, 8< Accessory Structures
BUILDER
OF
RECORD:
NAME:
PROPERTY NAME:
OWNER:
STREET ADDRESS:
LOCATION
8< PROJECT
INFO:
LOT #:
ADDRESS OF CONSTRUCTION:
~
~ ~':f 0lf1)
ESTIMATED COST OF CONSTRUCTION:
(EXCLUDING LAND VALUE)
SEWER lJTILITY
PROVIDER: C--,
NAME OF UTILTIY EXCAVATION CONTRACTOR; PLAN COMMISSION / BZA / BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'S (IF APPUCABLE):
FLOOD ZONE AREA DESIGNATION{S) . L \
FOR THIS PROPERTY: X 'Ui1$~04e.d.)
TYPE OF CONSTRUCTION:
XSINGLE FAMILY
o TOWN HOME
o TWO FAMILY
# of units being
constructed at this
time:
o RESIDENTIAL (For
Additions. Remodels. Etc.1
PROJECT INFORMATION:
Early Release
Permit:
Lot Split:
_v XN
_v~
TYPE OF IMPROVEMENT:
~EW STRUCTURE
'-6 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
Manufactured
Trusses:
Sump Pump:
YV_N
~Y_N
f\ \ 'S\...~\b(..
TAX MAP PARCEL #:
PLUMBING CONTRACTOR:
~ ~(<...
Plumber's Indiana State Li~ #:
I 0 SqOC]
Which plumbing codes will be applied to the construction:
o International Residential Code wjIndiana Amendments
~niform Plumbing Code w/Indiana Amendments
FOUNDATION TYPE: (Check all that apply for the new
construction area)
o CRAWLSPACE 0 POST & BEAM PIER
o SLAB BASEMENT (WALKOUT:_Y >\ N )
For Single Family an . e Ii . d.. , ccessory structures, this pennit is valid only if construction commences within 180
days of the date of~ttthaiir~~tYiidiU1iul'fl3ltbr4~8:l (Certificate of Occupancy issued) within 18 months of the issuance date. Class I
structure permits are subject tefl81'el!:~rnll~~!lr~~~~s of the State of Indiana (See 675 lAC 12) regarding expiration time frames for beginning and
nl"DT () ('r, I ,fjQlWllfl;ingconstruction.
I, the undersigned, a~khatlarty'J;;~~Jryi~l~itS,~rgtl:~~~location, or alteration of a structure, or any change in the use of land or structures
requested by this aI@fW~F q5'ntp~fvm~n i{'6}1fqtpyt~M-rutitla;(bt::.ltP; of the State of Indiana, and the ~Zoning Ordinance of Carmel Indiana -1993n (Z~
289) and amendments, adopted under a{;thq~~ 0 .C.jb~1 et secl:"Genera'r'A.s;embly of the State of Indiana, and all Acts amendatory thereto. I further certify that only
kitchen, bath, and floor drains are connectedUNI &y sewer. I further certify that the construction will not be used or occupied until a Certificate of
Occupancy I ~enis~nedb~t :Dep..tmentofConunUnityServices,Cmel,Indi~a. ~ (L.)(p ct/1/w
slg..tu...ofown"'o'A~ ori"'" Agent ~~ Date'
OFFICEUSEONLY:*********************************************************************************
SP-~CTIONS RE IRED: Filing Fees: -J:. 3 ~. "10'
upP; Footi) ower Footi Under Slab Base Inspections: -? 7 ::)0 # c~:~~e:;s Re-
~ Cert, of Occupancy:
mal Site
P.R.I.F.: Additional Fees
l '/dJ;>T~;'/
Dept. of Community Services (Date) ~<<~
S:Permits!Forms!IlP RESIDENTIAL
Fee Received by:
Date