HomeMy WebLinkAbout06100077 Application
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City of Carmel! Clay Township Permit #: 0 ~ 100 D 71
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, & Two Family: New Structures, Additions, Remodels, & Accessory Structures
BUILDER of
RECORD:
PROPERTY
OWNER:
LOCATION
& PROJECT
INFO:
SEWER UTILITY
PROVIOER:
NAME
STREET ADDRESS
ZI tJ z.. s. 1../4J1!6; Y1 oS +.
BUILDER'S EMAIL ADDRESS
NAME
Dees
WOrYIe5
STREET ADDRESS
{;4SO -re.IUo
Dr.
LOT #
SUBDIVISION NAME
CITY
FAX
f{iP -/.:50 7
STATE ZIP
L/t,Zt.-
Q~K
BEST METHOD OF CONTACT:
PHONE
34'1-'7 00
CITY
-:z:;:; db.
FAX
STATE
ZIP
SECTION
ZONING:
SQUARE
FOOTAGE: ISro s. F.
ESTIMATED COST OF CONSTRUcnON:
(EXCLUDING LAND VALUE)
NAME OF UTILITY EXCAVATION CONTRACTOR; PLAN COMMISSION / BZA I BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'5 (IF APPLICABLE):
TYPE OF CONSTRUCTION:
o SINGLE FAMILY
o TOWN HOME
o TWO FAMILY
# of units:
o MULTI-FAMILY
# of Units:
o RESIDENTIAL (For
Additions, Remodels, Etc.)
TYPE OF IMPROVEMENT:
o NEW STRUCTURE
o ROOM ADDITION(S)
o PORCH ADDITION(S)
o REMODEL
o ACCESSORY BUILDING
o DETACHED GARAGE
O/ATTACHED GARAGE
0" DEMOUTION
PROJECT INFORMATION:
Early Release
Permit:
FOUNDATION TYPE: (Check all that apply ~orthe new
construction area) /<'::~::~',::-.'. .
o CRAWLSPACE 0 POST 8< BEAM:. \'\ '\\'
Sump Pump: _Y _N 0 SLAB O<BASEMENT>"\~\ \"\\
/- \'~>'. '..\ ~--... \ \' \,\\
Does any part of the property lie within a special Flood designation area: _ Y -----:o--N;:;';-, ~; ~\I!ALKciUT:_ y.\\. \":~
For Single Family and Two Family dwellings. additions, remodels, and/or accessory structures, thi~;:p~~i{\~alid-only if cot\st~ n coiri~ebc~
within 180 days of the date of issuance of the building pe~it. and must be completed (Certificate cif~c~\upancy iss!!-Qd)\rithin 18 monJ-~'dfthe \
issuance date. Class I structure permits are sub~ect t~,the Gei1eral: d,ministrative Ru~es of the Stat~ of l,ndrah~See~'AC 12) rega..rding expir~3-on
U time,frames for begm ng and completmg constructIOn. \\ \\ \., . ~~,../-
I, the undersigned, agree that any construction, recbnsrruction, enlargem nt, relocation, or alteration of a struct,u\~, ~t:'~y chi\Ilge"in the usej?Lland or
structures requested by this application will corhply with, and conform to, all applicable laws of the State of lndia.n~, m'U,th€"'Zoning OrdIDance of Carmel
Indiana -1993~ (Z~289) and amendments, a.d6pted under auth ity of r.c. 6~7 et seq, General Assembly of the Sta\C' of Indiana, and,alIActs amendatoFr
thereto. I further certify that only kitche~(bath, and floor dr n are conn cted to the sanitary se'\ver. I further certtfy thal;..t:h~onstruction will not be
used cupied until a Certifica.te ofiOccupa.ncy has' n i ued by e Department of Community Services, €a~l, Indiana.
I ,...., wJso /(j;Jd/CJb
nature of Owner or Authorized A~nt Date I
OFFICE USE ONLY: ******~* i ***/~ff* *************************************************
\ "'j Filing Fees: J '5 -g . SO '
INSPECTIONS REQ~IRED: Base Inspections: ' ~ "'). 6" 0 # Cha~ged Re-
"..., """'" ..... -'\ "& c.rt. of -"'"'Y' ""~
Rough In Meter Ba.se Fin'at _ Site Additional Fees
~~I.~: I
,,~' o~
Fee Received by:
Lot Split:
Manufactured
Trusses:
_Y_N
_Y_N
_Y_N
Reviewed{
S:Permits/For
OiA.
pproved: Dept. of Community Services
IlL? RESIDENTIAL
PLUMBING CONTRACTOR:
Plumber's Indiana State License #:
o International Residential Code w II,
o Uniform Plumbing Code wI Indiana Amendments
(Multi-Family Construction Code)
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