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City of Carmel/Clay Township Permit #: D&Vf oqi
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATI N
For Single Family, Town Home, 8r. Two Family: New Structures, Additions, Remodels, 8r. Accessory Structures
BUILDER
OF
RECORD:
PROPERTY
OWNER:
LOCATION
8r. PROJECT
INFO:
kc
NAME'. I 'T) \ .
. l1<O\Me- "CM0J ~ l-'l
STRS24RSS: G. ( WI IN God
BUILDER'S EMAIl ADDRESS:
Ave.
NAME: L-OUl&
LOT #: &
SUBDIVISION NAME:
:5u.. W1()'\C V"
STATE~
FAX'
1SB-O\3S
ZIP:
L{.G,'::2o ~
l57
PHONE:
FAX:
STATE:l r..
ttZ~:o32
ZONING: S-;
13
SEmON: l
DRESS OF CON~umON:
,::;uAmme-r
SEWER UTIUlY WATER UTIUlY
PROVIDER: ,/" PROVIDER: ~
NAME OF UTIUlY EXCAVATION CONTRACTOR; PLAN COMMISSION I BZA I BPW DOCKET
NUMBERS; TAC DATE(S); ANDIOR CQUNlY WELL ANDIOR SEPTIC PERMIT #'S (IF APPllCABLE):
ESTIMATEO"COsT"C)F CONSTRUCTION:
(EXCLUDING:LAND VALUE)
; :il::; 'd ~
Pii\'//!
11!r.:._\<i I
;'1'11\,,1; A
"""'"
10lV rp
30 000
\:'11
FLOOD ZONE AREA DESIGNATION(S)
FOR THIS PROPERTY:
TYPE OF CONSTRUCTION:
~ SINGLE FAMILY
o TOWN HOME
o TWO FAMILY
# of units being
constructed at this
time:
~ RESIDENTIAL (For
Additions. Remodels. Etc.)
PROJECT INFORMATION:
Early Release
Permit:
Lot Split:
TYPE OF IMPROVEMENT:
o NEW STRUCTURE
o ROOM ADDITION(S)
o PORCH ADDmON(S)
o DECK ADDmON(S)
JEf REMODEL
_ Basement Finish only
o ACCESSORY BUILDING
o DETACHED GARAGE
o ATTACHED GARAGE
o DEMOLmON
SQUARE
FOOTAGE:
,lt1:1\;
'.1"'" ,
,r ,:r,;
did~fi
. L~~~_nli(I~!r
PLUMBING cC!lNTRACT()~:_-:::.--_.. '7l/lJ~~
N{A
TAX MAP PARCEL #: J
if" ""J.:~_:---:~:-~
Plumber's Indiana State License #:
Which plumbing codes will be applied to the construction:
o International Residential Code w/lndiana Amendments
o Uniform Plumbing Code w/Indiana Amendments
/' Man.ufactured
Y N TruSses:
Y ~sump Pump:
FOUNDATION TYPE: (Check all that apply for the new
~ construction area) ____--.-~-..--.----.
_Y ~ 0 CRAWLSPACE'- 0 POST & BEAM PIER
_Y _N & SLAB 0 BASEMENT (WALKOUT:_Y_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 pennit, and must be completed (Certificate of Occupancy issued) within IS months of the issuance date. Class I
structure pemuts a.re~ec WMtlfJ&f e State of IndIana (See 675 lAC 12) regardmg expiration time frames for begmnmg and
pleting constructIOn
I, the underSigned, agr e ,relocation, or alteratIOn of a structure, or any change m the use of land or structures
re ted by thiS apphcatIOn WI comply WIth, and conform to, all applicable laws of the State of IndIana, and the ~Zonmg Ordmance of Carmel IndIana - 1993~ (Z'
28 ) artd amendments, adopted under authonty of I C 36,7 et seq, General Assembly of the State of IndIana, and all Acts amendatory thereto I further certify that only
ki chen\bat oar drams are connected to the samtary sewer I further cerufy that the construcUon will not be used or occupied until a Ceraficate of
cup,,\,cyh ~tedbYtheDep"'tmentofCommu::=.-..-~;.Indlmt?cy-l'C f3 ~? 3 -()(p
Signature f ner or Authorized Agent Print ~ Date
OFFICE USE ONLY: *************** *******,~*********** ***********************'2)*********************
INSPECTIONS REQUIR : 11 1/7y Filing F es: . j, )'3 _ 5
G!iI- I III. d(!
Upper Footing Lower Footing Under Slab 3 : aO Bas nspectlons: . -
Cert. of Occupancy: S3,~O
!Rough Iii.:) Meter Base C!inal ~Site
# Charged Re-
Reviews
Additional Fees
C -ZlI-o(;,
Dept. of Community Services (Date)
S:Permits,fFormS/ILP RESIDENTIAL
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Date