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City of Carmel/Clay Township Permit #DfdyJOC07
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, &. Two Family: New Structures, Additions, Remodels, &. Accessory Structures
PHONE
31
FAX
31
33'1- -03"Tl{
BUILDER of NAME S 1Z It 'E"J if E;tJ (!o
RECORD:
ADDRESS OF CONSTRUCTION
J6:28 /f-
C\~W
PROPERTY
OWNER:
LOCATION
&. PROJECT
INFO:
SEWER UTILITY
PROVIDER:
STREET ADDRESS
LOT #
6.:z.(,-7d03
ZIP
CITY
STATE
1(. tt);;STMETHODOFCONTA'I#"u'H"~ ft~/9/l.
PHONE
FAX
317
STA~
SECTION
ZONING:
SQUARE
FOOTAGE:
04
NAME OF UTILITY EXCAVATION CONTRACTOR; PLAN COMMISSION / BZA I BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'5 (IF APPLICABLE):
TYPE OF CONSTRUCTION:
_ SINGLE FAMILY
o TOWN HOME
o TWO FAMILY
# of units:
o MULTI-FAMILY
# of Units:
~ RESIDENTIAL (For
Additions, Remodels, Etc.)
PROJECT INFORMATION:
Early Release
Permit:
_Y~
v '/1 0 CRAWLSPACE
Lot Split: _Y -LN Sump Pump: _Y,......-N 0 SLAB
Does any part of the property lie within a special Flood designation area: _ Y -p--N
TYPE OF IMPROVEMENT:
o
~
o
o
o
o
o
o
PLUMBING CONTRACTOR:
~Iu~er's Indiana State License #:
NEW STRUCTURE
ROOM ADDlTION(S)
PORCH ADDlTION(S)
REMODEl
ACCESSORY BUILDING
DETACHED GARAGE
ATTACHED
DEM ON
'1/ f ,/0
I'J . F DATION TYPE:
construction area)
Which plumbing codes will be applied to the construction:
International Residential Code w/Indiana Amendments
rm Plumbing Code wI Indiana Amendments
(Multi amily Construction Code)
Manu cture.(],
Truss s:
(Check all that apply for the new
t!:1- ~ !xv8,(Y\ (.
ST & BEAM"
BASEMENT hel it.<!.- t
WALKOUT:_Y_N f' ers
For Single Family and Two Family dwellings, additions e s, and/or ac ssory structures, this permit is valid only if construction commences
within 180 days of the date of issuance oft . mg permit, and m t be c mpleted (Certificate of Occupancy issued) within IS months of the
issuance date. Class I structure per' r.e subject to the G mi r~\c Rules of the State of Indiana (See 675 lAC 12) regarding expiration
ti es for beginning mpleting construction.
I, the undersigned, agree that any canst ctl reconstruction, enlattAfenr, c tibn, or alteration of a structure, or any change in the use of land or
structures requesred by this application " ly \~.,n~~forM \:0, all a ~~. nl?tc laws of the State of Indiana, and the "Zoning Ordinance of Cannel
Indiana -I993~ (Z-289) and amendments, 0 un~tnority of r.c. 36~7 q\ ~,encral Assembly of the State of Indiana, and all Acrs amendatory
thereto. 1 furrher cerrify that ooly kitchen~~\rh d floor drai?s are co~ee. r~ e ~itary sewer. IJurther. certify that the ~onstruction will not be
used or oc p d u 11 a CertIficate of O&.(f. ~en~t~ g~~.r..s.-me t of Commumty Services, Carmel, IndIana.
\,. ~\ O~;.t;:;'<S'riflIlEAJ CE A1 ao 7 - 07-- t?,6
Print' Date
OFFICE USE ONLY: *****************~*,j"c1******"'** *** **Z**~**tp,***************
'I' [Q J:\I!J:1J?ll!:lnc\, With all regulations _('"_a
SPECTIONS REQUIRED: of "lm~dneclTocal Codes. '~. >()
DEPT OF~~Pflv: SER"IGES / ::, (;. .> # Charged Re-
Lower Footing Under.&lab. 0 . . .~,J ReViews
~ \J 11' F CMNtlifloi:cSid~yTOWNSHIP S 3.:> V
Meter Base Final Site P.RJ~.?IANA Additional Fees
CO N 0 ITI 0 N Ii I TOT~L:/"7' ~ F tf
.---z/%c?tn~6&'
Reviewed/ pr ved: Oept. of Communily Services (Date) . .. (Y;' ,,/ Po
SIDENTlAL Fee Received bv: