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ClJ!'!!/t:armeIlC/ay Township Permit #QbOqo If.::.)
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.ESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, &. Two Family: New Structures, Additions, Remodels, &. Accessory Structures
,.lLDER of
RECORD:
STATE ZIP
-L-Ai
PROPERTY
OWNER:
.2
FAX
769
e.ell
7.53
STREET ADDRESS
;2&0
cm
v/h
STATE
-,....
LOCATION
&. PROJECT
INFO:
SECTION
StO;
~~~E: ,Sid'!
SEWER UTILITY ~_ .
PROVIDER: ~.
NAME OF UTILITY EXCAVATION CONTRACTOR; PLAN COMMISSION / BZA / BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'S (IF APPLICABLE):
ESTIMATED COST OF CONSTRUCTION:
(EXCLUDING LAND VALUE) 30CJ CJO(J
;.f 01;090 t 1:4
'.- :::~. i i
TYPE OF IMPROVEMENT:
% NEW STRUCTURE
. 0 ROOM ADDmON(S)
o PORCH ADDmON(S)
o REMODEL
o ACCESSORY BUILDING
o DETACHED GARAGE
o ATTACHED GARAGE
o DEMOLmON
8(' ',~ . 2006 1:\\ 1)
Plumber's Indiana S~te License #: ! :.:::J
~ oc)~rW l________.______.___.l
TYPE OF CONSTRUcnON:
.% SINGLE FAMILY
o TOWN HOME
o TWO FAMILY
# of units:
o MULTI-FAMILY
# of Units:
o RESIDENTIAL (For
Additions, Remodels, Etc.)
L Manufactured A FOUNDATION TYPE: (Check all that apply for the new
construction area)
_Y. N Trusses: _y' N
V . 0 CRAWLSPACE
Lot Split: _Y -X-N Sump Pump: ....p....Y _N 0 SLAB
Does any part of the property lie within a special Flood designation area: _Y
PROJECT INFORMATION:
Early Release
Permit:
Whic~bing codes wlli be applied t!!.~_e,construction:-_:_--_
~ntemational ReSld;~~i~ICO;" wI Indiana Amendinents
o Uniform Plumbing Code w/Indiana Amendments '
(MUlti-Family ConstruCtion Code)
o POST & BEAM
;8( BASEMENT
WALKOlJT:_Y ~
N
For Single Family and Two Family dwellings. additions, remodels, and/or accessory structures, this permit is valid only if construction commences
within 180 days of the date of issuance of the building permit, and must be completed (Certificate of Occupancy issued) within 18 months Or the
issuance date. Class I structure pennits are subject to the General Administrative Rules of the State of Indiana (See 675 lAC 12) regarding exPiration
. . time frames for beginning and comPleting~ft ~~~ ^ ~ 'lI .l!!.~ :
I, the underSIgned, agree that any construcoon, reconstrUcoon, enlargement, relacaoon, or al .. YP.!~ PI ~)lf~ge w';m~1!~, . f land or
structures requested by this application will comply with, and conform to, all applicable laws 0 e S ate ~a, '$tl the "'E:cirurig'~ ' of Carmel
Indiana - 1993" (Z~ 289) and amendments, adopted under authOrity of I.c. 36~ 7 et seq, General Assembly of the State of Indiana, and all Acts amendatory
thereto. I further certify that only kitchen, bath, and floor drains are connected to the sanitary sewer. I funher cenify that the construction will not be
used or ace pied un . . ate Q cup :r.: b n issued by the Department of Community Services, Carmel, Indiana.
/T/oa/-. ') #qrk1 hC'-J 9-';?9-of>
P"rint ... Date
OFFICE USE ONLY: *************************;i~~;;::s~*************~*tf.*i***************
INSPECTIONS REQUIRED: "
~ .= ~ Base Inspections: . , # Charged Re'
pper Footln ~ . ReViews
Celt. of Occupancy: . <5"3. .')(J
inal Site . . .
P.R.I.F,: / / cA '!. 00 Additional Fees
. ~OT~~S/ Z:!J ,
C"?.WJ...; /~ In-3-~ ~ . i
RevieWed/Approv'J: ti. of Community Services (Date) ,~ .
S:Permlts!FormsjILP RESIDENTlAl Fee Re elved by:
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