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City afCarmel/Clay Township Permit #: D&OQbV3..0
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, llr. Two Family: New Structures, Additions, Remodels, llr. Accessory Structures
BUILDER of
RECORD:
FAX
CITY~IMb/
STATE
~
PROPERTY
OWNER:
Bcr~:d::;ES@
NA~
~Ut~ BEST METHOD Of CONTACT:
FAX
STREET ADDRESS
STAT~
ZI40~
LOCATION
llr. PROJECT
INFO:
SQUARE
FOOTAGE:
WATER LfTILITY J ESTIMATED COST OF CONST~N:
PROVIDER: {!p-y ~ (EXCLUDING LAND VALUE) "-0' ~ ~
/L I"~ ~~
~~~~~~~~r:;'A~~~~~~~~OC~~~Rd~':~D;g~~~~~Np~:~r! :,~1I~~~~C;-CABLE) 'L m ~ hilt ;/lj ,{€f' ~ ~,
NSTRUCTION: TYPE OF IMPROVEMENT: PLUMBING CONTRACTO~/l/; r "-....~ P:;?';:~;,"-....
SINGLE FAMILY cW'NEW STRUCTURE :: I~ Pltl/l I ~~ j,f::0
o TOWN HOME 0 ROOM ADDITION(S) Plumber's Indiana State,Ucens.., l.:l?n_ //l!'
o ~~/;'7~~Y 0 PORCH ADDITION(S) r:.. 9 006,&,' 'il/b' jj/ /II~'
o REMODEL ~~/,j
o MULTI-FAMILY 0 ACCESSORY BUILDING Which plumbing codes will be applied to the CQ~ruction: I VIii
# of Units: I
O 0 DETACHED GARAGE 0 International Residential Code wi Indiana ll1endmen
RESIDENTIAL (For 0 ATTACHED GARAGE " I
Additions, Remodels, Etc.) 0 DEMOLITION V1Jniform Plumbing Code wi Indiana Amendments""-.... /
(Multi-Family Construction Code) '-I
SEWER UTILITY
PROVlOER: crP- tV
PROJECT INFORMATION:
FOUNDATION TYPE:
Y./ Manufactured Y /'N construction area)
~ Trusses: V N
- . ./ - 0 CRAWLSPACE
Lot Split: _Y _N Sump Pump: -1LY _N 0 SLAB
Does any part of the property lie within a special Flood designation area: _Y LN
(Check all that apply for the new
Early Release
Permit:
l2- POST & BEAM
lJ6 BASEMENT /'
WALKOUT:...L... Y_N
For Single Fa~,.a\lQ.J.vv,Q ~iW~IlK1~TVl~m'[SN. and/or accessory structures, this permit is valid only if construction commences
within 180 da:J1~~sruYt9: MM{~.~'trtl\:11~1.p.e.nnlf..llll.d must be completed (Certificate of Occupancy issued) within 18 months of the
issuance date. C$t.ibjecb~~~BJl~tl~~atl:\".u,,"dministrative Rules of the State of Indiana (See 675 lAC 12) regarding expiration
'of State and LocllhGatie&s for beginning and completing construction.
I, the underSign~r8B'ft~', '. fir,{N~ttNl~~_tG ment, relocation, or alteration of a structure, or any change in the use of land or
structures requesMHlfthis )l~.tr' ..0 o.H'Urin COJllE1}:.. ~ W!l , , all applicable laws of the State of Indiana, and the "Zoning Ordinance of Carmel
Indiana -1993"GflBt)@p:a .... ~~e . . 36~7 ct scq, General Assembly of the State of Indiana, and all Acts amendatory
thereto. I further certify tpa~ ~nl -k!~ ' pij floor drains are connected to the sanitary sewer. I further certify that the construction will not be
usedo occup~d I Cere' ca cCUpanCjhaSbeenissue~;rOfCo~;tY2;Vel'Jndiana. C}-( ;-Of;:;,
Signature of Owner or Authorized Agent Print Date
OFFICEUSEONLY:******************************************************~****************
()~ Filing Fees: / :3 71, OU
INSPECTIONS REQUIRED: * ,,,? ':::l 3 :
Base Inspections: .;;) ,;.) . 00 # Charged Re-
r_ :? r "" Rer'ews
Cert, of Occupancy: ::>J.~l v v
P.R.LF,: II.).€- f I () {j Additi~nal Fees
4$ 3p?. (p. SO
q-J~O
q-
~
Reviewed/Approve Dept. of Community Services
S:Permlts/Forms/ILP RES DENTlAL
(Date)
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