HomeMy WebLinkAbout06100144 Application
BUILDER
OF
RECORD:
PROPERTY
OWNER:
LOCATION
&. PROJECT
INFO:
City of Carmel/Clay Township Permit #:010 100 L:iq
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Town Home, &. Two Family: New Structures, Additions, Remodels, &. Accessory Structures
PHONE:
FAX:
S-72[{
BUILDER'S EMAIL ADDRESS:
STATE:
JJ
BEST M~OD OF CONTACT:
\J fJlJN e: ?OS- 7211
PSE; f - Dft;4<{
ZIP:
?-.
CITY:
CMmrZ:L
~
FAX:
ZIP:
I~ET4qRESS:
31
SUBDIVISIODAME~ S
ESTIMATED COST OF CONSTRUcnON:
(EXCLUDING LAND VALUE) Z:) ozi\:::)
FLOOD ZONE AREA DESIGNATION(S)
FOR THIS PROPERTY: ~
TAX MAP PARCEL #:
TYPE OF CONSTRUCTION:
~SINGLE FAMILY
o TOWN HOME
o TWO FAMILY
# of units being
constructed at this
time:
o RESIDENTIAL (For
Additions. Remodels. Etc.)
FOU DATION TYPE: (Check all that apply for the new
o r~o;~:~PACF/O POST&_BEAM ~
o SLAB ;;;:ASE~ENT~.A ;,-,,",f{,7~';'
,... 1 .tjt:t\.....-----
For Single Family and Two Family dwellings, additions, remodels, and/or accessory structurJi\. .......t ~ v i~~~'X(~qQ~iicQf'~o~~Wwithin 180
days of the da~e of issu~ce of the building pe~t~ and ~ust be completed (Certifi~ate of OS~\i:sn~,..~)i~, hS Ptl?~ffisefvthtt~'iuance date. ~Iass I
structure pemuts are subject to the General Adrnuustral:1ve Rules of the State of Indiana (See 675 lAC IVf~ng expmuJOTI tun~Jr~"f.t5lJllng and
completing construction. n~ COMMUNITY vI:.
I, the undersigned, agree that any construction, reconstruction, enlargement, relocatIOn, or alteratildIiii?Jru'dure, or any ~ange,inlth~..~e'Pn~l}'lNGbUl?res
requested by this application will comply with, and conform to~pplicili1e. aws of the State of~, 6FICJMtii~ 6roirlahd.J'df t'annenndiana -1993" (Z'
289) and amendments, adopted under authority of LC. 3.9-"r-cl seq, General Asse bly of the State ~&i~na, and all Acts ar\'~~~~reto. I further certify that only
kitche ath, and floor drains are connected to the s tary sewer, I further cer. that the construction will not be used' or occupied until a Certificate of
eeu eyhas been issued by the Department Community Semees. C I. Indiana. :f..- ~IIJ ~ SID II '2-/iJ?p
MBING CONTRACTOR:
N~A
Plumber's Indiana State Licens #:
Which plumbing codes will be applied to the construction:
o International Residential Code w IIndiana Amendments
o Uniform Plumbing Code wI Indiana Amendments
PROlECTINFORMATIOlt:~
Early Release /. /
Permit: Y ~
Lot Split: _V_N
Manufactured
Trusses:
V<
--"~
_V~
Sump Pump:
OFFICE USE ONLY: **********
Date
INSPECTIONS REQ
Upper Footing Lower Footing Under Slab
CRo~-Meter Base ~ Site
**************************~*~************************
//L.5 '---0
Filing Fees: j . J
//I'.(/t/
53 SO
Base Inspections:
# Charged Re-
Reviews
Cert. of Occupancy:
P.R.I.F.:
Additional Fees
I O~2<..( c6
Dept. of Community Services (Date)
S:PermltsfFormsfILP RESIDENTIAL
Fee Received by:
Date