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City of Carmel/Clay Township Permit #:t2!f /ftO /1V
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Town Home, &. Two Family: New Structures, Additions, Remodels, &. Accessory Structures
,-'-, SECTION:
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1(/ '/ ESTIM~OST OF CONsTRUCTION' -
I L (EXCLUDYrlG -LRl VALUE) - -~; ':' : ~ qL)
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NAME OF UTILITY EXCAVATION COtrrRACTOR; PLAN COMMISSION / BZA / BPW DOCKET '_______ ''-...... Vs /1 /1
NUMBERS; TAC DATE(S); AND/OR COUN1Y WELL AND/OR SEPTIC PERMIT #'5 (IF APPllCABLE): '''___ RE(.l;~ASED'iQR CaNST .! II-:T ()y,!
FLOOD ZONE AREA DESIGN!:TIClN(S) V / L _ D _..J T' H. ~lR'ar-~ir\.c" wW, all Rl"9uln!lcm ,
FOR THIS PROPERTY: ~ ..1\ lUnSI'l.llO'W '-...... of ~H?re frs~l Loce'll CDdes
BUILDER
OF
RECORD:
PROPERTY
OWNER:
LOCATION
&. PROJECT
INFO:
SEWER UTILITY
PROVIDER:
LOT #:
~\
TYPE OF CONSTRUCTION:
)!:( SINGLE FAMILY
o TOWN HOME
o TWO FAMILY
# of units being
constructed at this
time:
o RESIDENTIAL (For
Additions. Remodels. Etc.)
PROJECT INFORMATION:
Early Release
Permit:
Lot Split:
y~
y~
TYPE OF IMPROVEMENT:
o NEW STRUCTURE
o ROOM ADDmON(S)
o PORCH ADDmON(S)
o DECK ADDITION(S)
j)l(REMODEL
_ Basement Finish only
o ACCESSORY BUILDING
o DETACHED GARAGE
o ATTACHED GARAGE
o DEMOLmON
Manufactured ./
Trusses: _Y ~
Sump Pump: _Y v1J
tf7t;. D]q~
41//J!:b
ZONING:
'..'
Plumber's Indiana State license 'if: ',_4 .,.....".
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Which plumbing codes will be applied to the construction:
o International Residential Code w/Indiana Amendm~nts
);i('Uniform Plumbing Code wI Indiana Amendments
FOUNDATION TYPE: (Check all that apply for the new
construction area)
o CRAWLSPACE 0 PCST & BEAM _PIER
o SLAB 0 BASEMENT (WALKOUT:_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 pennit. and must be completed (Certificate of Occupancy issued) within 18 months of 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 construction.
I. the undersigned, agree that any construction, reconstruction, enlargement, relocation, or alteration of a structure, or any change in the use of land or structures
requested by this application will comply with, and conform to, all applicable laws of the State of Indiana, and the ~Zoning Ordinance 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 ar connected to the sanitary sewer. I further certify that the construction will not be used or occupied until a CertiIiate of
Occupancyh heeni",u~dby tmentofCOmmUnityservie."C~a;iii1 . 4(0;0 _ldtilj/tP
Signature 0 Print ~ Date
OFFICE USE ON . ****************************************************:J::j*************************
INSPECTIONS REQUIRED: Filing Fees: J' ...s- 0
///~ eO
,~3 ,5'0
Upper Footing
0Ug~
Lower Footing
Meter Base
Under Slab
Base Inspections:
Cert of Occupancy:
# Charged Re-
Reviews
~I
~
Additional Fees
~J(}-fJ6
(Date)
P.R.I.F.:
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Fee Rece,: by: ~
"
Date'