HomeMy WebLinkAbout06110015 Application
City of Carmel/Clay Township Permit#: tJldll (JOtS
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, &. Two Family: New Structures, Additions, Remodels, &. Accessory Structures
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FOUNDATION TYPE: (Check all that apply for the new
construction area) I
o CRAWLSPACE 0 POST & BEAM
Lot Split: _ Y ----"".N Sump Pump: -XL. Y _N 0 SLAB .JIg> BASEMENT
Does any part of the property lie within a special Flood designation area: _Y -E-N WALKOUT:_Y~N
For Smgle ~~~nd . ~^"',Ot ;_r~~sls, and/or accessory structures, thIS permIt IS valid only If constructIOn commences
_."'Ithm 18" IS ~~~e;pWff'li'~W~r!"nd must be completed (Cernhcatc of Occupancy Issued) wlthm 18 months of the
'~ t!~~uance date.~. R~ilfe S~bJli:~~.?e General AdmIOlstratlve Rules of the State of Indiana (See 675 lAC 12) regardmg explratio~
.., , < ~State and Loca tl'6l ~~fI~nnmg and completmg constructIon.
I, the underSigned, a~ ~~~N.\1clfu ~jf,K e a em, relocatIon, or alteratIon of a structure, or any change m the use of land or I
J strUctures req~tl}rth ~~~~~i'fr ~~ to all applicable laws of the Srate of IndIana, and the uZonmg Ordmance of Carmel
; Indiana - 1993" ' ~ ~ ' under authOrIty of I C 36~7 et seq, General Assembly of the State of Indiana, and all Acts amendatory
1!. t'thereto, I furt c r lfychat only kitlNti")J~ "Ad floor drams are connected to the sanItary sewer I further certify that the construction wIll not be
'~,~f~.7 used o~,.occupled until a Ci:rtificate'ol15ccupancyhas been Issued by the Department of CommunIty ServIces, Carmel, IndIana \
~~ ~f::ffiZ€Y TauS IO.>~' '?6
Signature of 0 r :tJIJ.ho~ed A;ent Print Date I
OFFICE USE ONLY: **************************************** *********~***2(~**************
./ ~ Filing Fees: J2,;) I I
INSPECTIONS REQUI : IV. , . . ___ '
Base Inspections: d 17. ,,\ 0 # Char~d Re-
,- ReVIews
Cert. of Occupancy: <5 3. s' 0
I;). (, ( r1 0
t.lt( 3 'to
. jD II
BUILDER of
RECORD:
NAME
-S~E. ~UTZ
STREET ADDRESS fI
I D I \P '3 tU> M" S.." "5V Ilt' lCO
. ,
BUILDER'S EMAIL ADDRESS
Pf6tlFSUS 1<'1 C AD L- .W.""
PROPERTY
OWNER:
NAME
~!WT2:.
-z:n;:\f E:..
STREET ADDRESS
"5kM€ A":>
LOCATION
&. PROJECT
INFO:
LOT #
SUBDIVISION NAME
UW~
SEWER UTILITY A
PROVIDER: r; kZ-M IfL
NAME OF UTIUTY EXCAVATION CONTRACTOR; PLAN COMMISSION / BZA / BPW DO KET
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'S (IF APPLICABLE):
TYPE OF CONSTRUCTION:
TYPE OF IMPROVEMENT:
>'e! NEW STRUCTURE
o ROOM ADDITJON(S)
o PORCH ADDITJON(S)
o REMODEL
o ACCESSORY BUILDING
o DETACHED GARAGE
o ATTACHED GARAGE
o DEMOLITION
:8l>
o
o
SINGLE FAMILY
TOWN HOME
TWO FAMILY
# of units:
o MULTI-FAMILY
# of Units:
o RESIDENTIAL (For
Additions, Remodels, Etc,)
PROJECT INFORMATION:
Early Relea.se
Permit: " _ Y l,O N
Manufactured
Trusses:
_Y 'ON
Lower
Rough In
inal
Site
P.R.I.F.:
PHONE
FAX
SI4.ZZ3/
[) 4-"- - ((;{',.f "Z
CITY
(!.A-/l.NIet...
STATE
IND,
ZIP
4G:,lCl'?2
B4f:d:?b<\Z
BEST METHOD OF CONTACT:
PHO~E
FAX
STATE
ZIP
ZONING:
l:":
4028
SQUARE
FOOTAGE:
'- ........ .' ~~
ESTIMATED ~OST OF CONSTRUCTION: /'.-rv>,.!XlO ,0':;'
(EXCLUDING LAND.y~6E) """",-,.
E'L,fc. 8clJvai,~
PLUMBING CONTRACTOR:
(V\\UJe'R PU)(I/\6/1.JGr
Plumber's Indiana State License #:
Pc.. i 'lei? 00 0 ~'1
Which plumbing codes will be applied to the construction: I
~ International Residential Code wI Indiana Amendments
o Uniform Plumbing Code wI Indiana Amendments I
(Multi-Family Construction Code)
INC,.
Additional Fees
C~Cy H/S-e/v ll-'X~o(;
Reviewed/Appro~ed: Dept. of Community Services (Date)
S:Permits/Forms/IlP RESIDENTIAL
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