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City of Carmel/Clay Township Permit #: O&()'lOD5Co
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, & Two Family: New Structures, Additions, Remodels, & Accessory Structures
BUILDER of NAME ~Vi -$6J,.1t.fft PHONE f;4W (#tb1z FAX !3/4' ZZ3/
RECORD: t ''E: qMtDa (/'It,
STREET ADDRESS >,eo nve -5)/". 'Sh =tI- /fJ.';> CITY STATE ZIP
IO/fJ? C,wIVEEL irJ 4&032
BUILDER'S EMAIl ADDRESS BEST METHOD OF CONTACT:
Pflr~.s 79 e Aol.'-cm ~-0G4z
PROPERTY NAME K:vB- ;uelJp.,.J, ez. PHONE gAB. SI/Z FAX
/.
OWNER:
STREET ADDRESS CITY STATE ZIP '7
:;2~4- i-l-A'v-> Tl.H',u..:,e- l)". W~T. (!M-Mef., :8IIf' I tV .
LOCATION LOT "M l23sUB~~;" SECTION ZONING: ~
& PROJECT /=l'l::6C
INFO: ADDRESS OF CONSTRUcnON SQUARE 4<;0+
~2. ~4 . 'TlIoiZIJi:. 1>P. ~ FOOTAGE:
SEWER UTIUTY ~ WATER lJTILfTY _ I ESTIMATED COST OF CONSTRUCTION~ Jt 0 CJ -:':2
PROVIDER: PROVIDER: (UI'1'1~ <- (EXCLUDING LAND VALUE) P, G .
NAME OF UTIUTY EXCAVATION CONTRACTOR; PLAN COMMISSION I BZA / BPW DOCKET
NUM~~RS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'5 (IF APPLICABLE):
FOUNDATION TYPE: (Check all that apply for the new
construction area)
Ji5' CRAWLSPACE 0 POST & BEAM
Lot Split: _Y --tLN Sump Pump: _Y ~N 0 SLAB 0 BASEMENT
Does any part of the property lie within a special Flood designation area: _ Y ~N y.:&L~OUT;--Y~N
-.-- .,~), "
For Single F~~rrd I~e0tnlN9Q1awCT~s. and/or accessory structu~efi . ,~~'fcl"'fl~tYAt~J~~.~ Vpmmences
within 180 d~;;Jp.!I.M!i'~ Issw.j)~ell.l\i\<\'!l!llllta>liOOlhd must bc completcd (CeWfr~t )x!0(SUj>~ri<f~"edI~\9~'o/\\1!."I'\hS olchc
issuance date. S1tb4e~ffftIh\RHftts <;lfe s';l ~F'",~~e General Administrative Rules of t~~ sdi~ Inaiana'(Set'-675 lAC 12), ,~i ~lexpiration
of stale and L.oca ih\l'rr~'ll.i;s~","\><l!inning and completing con~'1'4'" . ~m; i \ \ \ \ i I
'. I, the undersignf'lt!~ tt:J~0M~\rR6rSfDl:1i'Mrt~ement, relocation, or alterati~n . I\Ucru~P;tnl: HYhe\ ~ a~d or
strucruresrcqueM~ythisa i ~.'m p " NSMNfb,allapplicab]ela\Vsofth~,. rn~a_~ gOtd~1 'otCarmel
Indiana - 1993~:GId ,-alIa under autnority of J.c. .36-7 et scq, General Asse~ ' ~~.d.ianaf'anthd~A ~+dhory
thereto. I furthercenify that only kittNtD\!A Ad . re connected to the sanitary sewer\ nher cert' y~that-the-coMtruction w\i:.!~ot be
used or occupied until a Certific e of Occupa. yhas been issue the Department of comml-Int crvices, Carmel.Jndiana. j
Jp.rF eu1.:L ------ cr'/Z.Ob
********************~*************************
Filing Fees: . ?/. ,)"0
Base Inspections: /,t C <;0 # Charged Re-
/ ' - ReViews
Cert. of Occupancy: -)3. :5'"tJ
~~~:"" yO/. i';'-~'
Fee Received by:
TYPE OF CONSTRUCTION:
o SINGLE FAMILY
o TOWN HOME
o TWO FAMILY
# of units:
o MULTI-FAMILY
# of Units:
~ RESIDENTIAL (For
Additions, Remodels, Etc.)
TYPE OF IMPROVEMENT:
o NEW STRUCTURE
~ ROOM ADDmON(S)
o PORCH ADDmON(S)
o REMODEL
o ACCESSORY BUILDING
o DETACHED GARAGE
o ATTACHED GARAGE
o DEMOUTION
PROJECT INFORMATION:
Early Release
Permit: _Y ~N
Manufactured
Trusses:
_Y ~N
Authorized Agent
OFFICE USE ONLY: ********
INSPECTIONS REQ RED:
~pe(i:ooti~Lower Footing Under Slab
~OUgh~MeterBase ~
c
,
\
Reviewed/Approv d: Dept. of Community Services
S:Permits/F~mS/ILP RE IDENTIAL
PLUMBING CONTRACTOR:
tUluIerL fl-vfV1.I>INI1
Plumber's Indiana State License #:
pic 19~ OotJ 81
(JP 1iff'iC.1'Jt.)
Which plumbing codes will be applied to the construction:
~ternational Residential Code wjlndiana Amendments
o Uniform Plumbing Code wjlndiana Amendments
(Multi-Family Construction Code)
Date