HomeMy WebLinkAbout06110019 Application
City of Carmel/Clay Township Permit #:~ ~ 't
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Town Home, &. Two Family: New Structures, Additions, Remodels, &. Accessory Structures
STREET ADDRESS:
iDe;; W. ~a.
BUILDER
OF
RECORD:
&
N' 4&D3 2-
FAX:
-72/ {
€I--
BUILDER'S EMAIl AD~ESS:
LhE"1 "l-E:Se.J-roQ..J \-l.\-\ol'V\eS . CDYV1
BEST METHOD OF CrT~:
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PROPERTY
OWNER:
PHONE:
(or--J
STRm39D:$?~~~S ~~ W-M8L
LOT #g SUBDIVIS ~Afj~ [:A'I2.JI/l S
AD3SS9DSTRSp~~ ~S
LOCATION
&. PROJECT
INFO:
SEWER UTILITY /lA...IJ AJ1A <7
PROVIDER: l-I"rt""~~L----
FAX:
STATE:
I N
ZIP:
L.{ 0c) 3 2.
WATER UTIlITY /".A 11 JA A IC7
PROVIDER, ~VL t:C-
E~ATED COST OF CONSTRU
(EX 1iii1~~,I'.~~~l...,~.
_ "".~.".' , 1', "'~
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........ l'~[;( ~tj 'i ".""",.-, ,_. . . _ '-'\,. n1" -,"" J lfJrJ
~~~;;7Z ;,:~;r;r;;,~.1 :~:~~~:,E~?lli~!iqng
NAME Of UTILITY EXCAVATION COMTRACfOR; PLAN COMMISSION / BZA / BPW DOCI<ET
NUMBERS; TAC DATE(S); ANDIOR COUN1Y WELL ANDIOR SEPTIC PERMIT #'5 (IF APPUCABLE):
TY~E ~;::::u:~::NT: PLUMBING CONTRACTORi)!cic,;/'A-
o ROOM ADDITION(S) JPlumber.s Indiana state License #:
~PORC ADDITION(S) A--
o ADD~~l~)
REMODEL ~Fl.. Vt 6{)/A17 Which plumbing codes will be applied to the construction:
_ Basem nt 1n,~Vd~~y
o ACCESSORY BUILDING 0 International Residential Code w/Indiana Amendments
o DETACHED GARAGE 0 Uniform Plumbing Code w/Indiana Amendments
o ATTACHED GARAGE /
:~~J:~a::FORMATIOY M:uf:::~ON 7(// ~~n~~~~~O:.e~PE: (c;;~;a~7~a~jY.fOrthelneW
Permit: _Y ~ Trusses: _Y _ 0 CRAWLSPACE'.-.p:...~OST.&.__,__..'BEAM_PIER
Lot Split: _Y Sump Pump: _Y _N 0 SLAB 0 ,BASEMENT (WALKOUT:_Y_N )
._.' 1\ t"\(\e
For Single Family and Two Family dwellings, additions, remodels, andJor accessory structures, this pennit is viiiao11y if c~~ct1On o~~nces withm 180
days of the date of issuance of the building pennit, and must be completed (Certificate of Occupancy issued) ~ihin' 18 months of the issuance datt;JClass Ii
structure permits are subject to the General Administrative Rules of the State of Indiana (See 675 lAC 12) regardirig h:piration time frames foroeginning and
completing construction. \..:. -- 'k"-' -'~-
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 t is application will comply with, and conform to, all applicable laws of the State of Indiana, and the "Zoning Qrdinance of Cannel Indiana -1993n:,<z~
289) and am ents, adopted under authority of I.e. 36.7 et seq, General Assembly of the State of Indiana, and all Acts amendatory thereto. I further certify that only
kitchen, ba , d floor drains are connected to the sanitary sewer. I further ce . that the constru.cti\}\ will not be o,ed Ot occupied until a certilfaj of
Dcc ",been- ue the.!:'epartmento!Community5etvice,.Cann ,Indiana. ~UPlrI8 /l1110Cp
Slg re of Owner or AuthOl'iled Agent Print Date
OFFICEUSEONLY:*************************************************************(j******************
INSPECTIONS REQUIRED: (!, ..filing Fees: /3 ~ , ~
. . "/15 Base Inspections: / / I ~ 00
Upper Footing Lower Footing Under Slab . AI!:';;? .. e-Q
Cert. of Occupancy: ,::.L.J. ;;l
tR;;;.gh Id Meter Base ~ Site)
~ ~ P.R,I.F.: Additional Fees
~lOJAL: j JI'A1g.00 ,
J1l ~ /t//t6'/o7-
Fee Receive y: Date
FLOOD ZONE AREA DESIGNATION(S)
FOR THIS PROPERTY:
TYP
NSTRUCTION:
SINGLE FAMILY
o TOWN HOME
o TWO FAMILY
# of units being
( constructed at this
)! RE~~~NTIAL (For
rI f\AdditiOns. Remodels. Etc.)
NA
C I ;.f;XJfe;0\~:'(~1!~;i;.;;
,.'c :', ~
# Charged Re-
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