HomeMy WebLinkAbout06100104 Application
City of Carmel/Clay Township Permit #: !JCe Jootoj
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, & Two Family: New Structures, Additions, Remodels, & Accessory Structures
BUILDER of
RECORD:
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ZIP
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~~EET ADDRESS t""\ +- CITY
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STATE
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PROPERTY
OWNER:
BEST METHOD OF CONTACT:
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3(~~tr~~ ~S1 '-/
FAX
31"1 lW?..YJo"'''-/
ZIP
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LOCATION
& PROJECT
INFO:
STREET AD S
~~~.
Lcel 1\ \
ADD~s~'13m
Z~Nr
SQUARE c-C1 /
FOOTAGE}.::> 1:;
SEWER LfTIL~ ~___ . WATER UTILI}\ I^"_ _. _ n
PROVIDER: ~"-'NO PROVIDER: ~
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):
ESTIMATED COST OF CONSTR~~
(EXCLUDING LAND VALUE) e:xJ D
o~
o ~ 100ft) ~
~
TYPE OF CONSTRUCTlON: F IMPROVEMENT: PLUMBING;;NTRACTOR:
~ SINGLE FAMILY NEW STRUCTURE C1rl~
b ;~;F~:~~ 0 ~g~~H A~g~~~~~~) :Jmber~~.n 'ana S te License #:
o REMODEL ~
o MULTI-FAMILY 0 ACCESSORY BUILDING Which plumbing codes will be applied to the construction:
O # of Units: 0 DETACHED GARAGE 0 International Residential Code w/Indiana Amendments
RESIDENTIAL (For 0
Additions, Remodels, Etc) ATIACHED GARAGE D 1lI)lfl!,"l1-~'l'nlli!J5I.~951U"J..f,[1fliana Amendments
o DEMOLITION RELEASED ~t~F\imiIi,<<!1J1,.tI'il~,," tlJ.ill)'4
PROJECT INFORMATION: Subject to cC2[0p'liancG with all rEll)ulations
Early Release Manufactured of ::fi\lW~~i!1Q1l! ~. (Check all that apply for the new
Permit: _y.:i-N Trusses: "-ioE~T oF"~8R!:%\'t~~,;ft SERV).QES
Lot Split: _Y ~N Sump Pump: ~~OF C,~~~rff~r;;r:TO~~~M&E~~M
Does any part of the property lie within a special Flood designation Q~~ w IA:'J-f\ N WALKOUT:_ Y_N
Fo~ Si~gle Family and Two Fa~ily dwellings, ad~iti?ns, tem~dels. and/or accessory structur~s: this permit\i~~li~-.~.!!JY;~f<;~ry~~~~-fo~~~~e~\':~ ~
WIthm 180 days of the date of Issuance of the bUIldmg permIt, and must be completed (CertIfIcate of Occup~nfY lSE~"ed)~lclii~Q_ntlis:ofth~ \ 1. \
issuance date. Class I structure permits are subject to the General Administrative Rules of the State of lndia~# (~~eI.675"IACI2)regarding expir~t~Oli \1
time frames for beginning and completing construction. \ \ \..1 } \ \ \ \ \ \
I, the undersigned, agree chat any construction, reconstruction, enlargement, relocation, or alteration of a structur~,II~r.~ny chal}&r-~ tht ul11.9W or \ \ \ I:
structures requested by this application will comply with, and conform to, all applicable laws of the State of Indian~,14nc~'tpe ~Z\;&.ng Oklirnmce of Cannell} /
Indiana -1993" (2- 289) and amendments, adopted under authority of I.c. 36-7 et seq, General Assembly of the State, e:{ r~a~ana, and all Acts amendaroryJ L~
thereto. I further certify that only kitchen, bath, and floor drains are connected to the sanitary sewer. I further certify thit.~he,construction-W:innotbe
used or occu ied unti'!J:f'ertillcate of Occupancy has been issued by the Department of Community Services, Carmel, Indiana. ,_ _______- j
\ C'RJ ~ \-\r hel/-------l ~-IID_rlS(p
Signature of OWner or Authorized Agent
Print
Date
OFFICE USE ONLY: ****************************************************~*******************
Filing Fees: h :2 A ~()
INSPECTIONS REQUIRED: -, 7 7' ~/1
~ Base Inspections: ~ oJ u
pper Footi g Lower Footing ab ,~_ .C::O
Cert. of Occupancy: J ,:1" ./
ciDug~n er Ba Final I r7. /( (/() Additional Fees
_ . P,R.IF: i2,
TOTAL: $"';2.;2/;/?O I
~~(j ir)J~~ 10/%/01>
# Charged Re-
Reviews
Reviewed/Approved: Dept. of Community Services
S:PermitsjFormsjILP RESIDENTIAL
(Date)