HomeMy WebLinkAbout06100004 Application
C't ifc IIC" 'T' h' Permit #:fXoIO ono'-j
t y 0 arme ,ay .L owns tp I
COMMERCIAL/INSTITUTIONAL/MUL TI-F AMIL Y IMPROVEMENT LOCATION PERMIT
APPLICATION (For New Structures, Additions, Remodels, Tenant Finishes, &. Accessory Buildings)
BUILDER
OF
RECORD:
NAME:
R~c. I C~......~....l Cc~h'~~lcfl
STREET ADDRESS:
., ? () !f: t/6'" ff. .r:A~ IJJ
PHONE:
5.1.,.,.,. 1/,4
CITY:
,,.,,.........1
FAX:
)11.r<1 -?JIO
STATE: ZIP:
:1AJ 't(,;},6
BUILDER'S EMAIL ADDRESS:
~.5b1-'-I172
. .^"
BEST METHOD OF CONTACT:
Frl_ J'
PROPERTY
OWNER:
NAME:
PHONE:
FAX;
L r~e.. I Pr~ "rfi~J' LLe.
STREET ADDRESS:
1:Ll3a;;. al.) 11"'r.J;~ n.
CITY:
C-.r-...I
Lr~..1 3,J
,
STATE:
:::rr-1
ZIP:
'16J7.::l
LOCATION
S. PROJECT
INFO:
ADDRESS OF CONSTRUCTION:
5'. f'..~ Ji.-..... p.
SUITE #: (If Applicable)
SCOPE(S) OF
RELEASE: 0
Lot # and Subdivision: (If Applicable)
Address of Shell Building: (If different than Address of Construction)
C-L
SQUARE ;;lO1 55S'
FOOTAGE:
BUILDING, PROJECT, OR TENANT NAME:
t:::r_c..rrf"-"f- DL_f:.4r,
TAX MAP PARCEL #:
STATE COMMERCIAL
DESIGN RELEASE #: ") '11 I J' 'l
o ARCH 0 MECH
OTHER(S):
WATER UTILITY
PROVIDER:
Urf1L<1
SEWER UTILITY
PROVIDER:
ar
ESTIMATED COST OF CON$TRUmON:
(EXCLUDING LAND VALUE) i tl:>,. .'lOO
PLAN COMMISSION / BZA / BPW OOCKET NUMBERS; AND/OR
COUNTY WELL AND/OR SEPTIC PERMIT #'5 (If Applicable):
# of Aoors: 1- Elevator or Uft: Q YES BLDG. CONSTRUcnON lYPE: /1-1. 5fl< OCCUPANCY QASSIFlCATION:
PE OF CONSTRUCTION: TYPE OF IMPROVEMENT: PROJECT INFORMATION:
COMMEROAL t;{' NEW STRUCTURE
(Privately owned hospItals and medical 0 ADDmON
offices/centers are commercial) 0 Room(s)
o INSTITUTIONAL "'~ Q, 1f?~nnN
o Munidillii/P.W!k,BldiP FOR CONStj,lM\dz~nlneorDeck
o Sch~ubject to compli8nCcGlittREMODELulations
o Church of State and LSal NEWJTENANT FINISH
o MULTI-FAMIl,'(~PT OF COMMUPITACc:~?~q~"i,B\!I'AING
Number of ul1it\l;: _ 0 DETACHED GARA\'iI;,
FOUNDATION TYP~I~eQfal~.Q,\1:~~EL / QJ~~t%:~~f
app.lY for the new construction area) IN 0 I~ A CELL TOWER CO-LOCATE
'0 SLAB 0 CRAWL SPACE 0 DEMOLfTlON
o POST&_BEAM _PIER 0 BASEMENT (WALKOUT:_Y_N)
IJ
Sump Pump:
Y/N
-Y/N
Early Release /
Permit: _Y lL~
Lot Split: _Y ~N
Manufactured
Trusses:
PLUMBING CONTRACTOR:
13ft 1Z'()~
Plumber's Indiana State License #:
Class I structure permits are subject to the General Administrative Rules of the State of Indiana (See 675 lAC 12) regarding expiration time frames for beginning and
completing construction.
I, the undersigned, agree that any con truction, reconstruction, enlargement, relocation, or alteration of a structure, or any change in the use of land or structures requested by
this application will comply with, confonn to, all applicable laws of the State of Indiana, and the UZoning Ordinance of Carmel Indiana - 1993" (Z-289) and amendmen~,
adopted under authority of I . 3 et seq, General Assembly of the State of Indiana, and all Acts amendatory thereto. I funher certify that only kitchen, bath. and floor drafus are
connected to the sanitary . 1 further certify that the construction will not be used or occupied until a Cerrilica.te of Occupancy or Subst;mtia/ Completion has been
issued artme Community Services, Carmel, Indiana.
Signato
/
"'Ow
p/l,,~
K~......lr"'--
Date
11'J Ii/D6
,
Under Slab
Base Inspections:
OFFICE USE ONLY: ********************************************
Filing Fees: "',
~ECTIONS REQUIRED'
ReviewedjAp oved: Dept. of Community Services
S:Permits/formS/IL COMMERCIAL