HomeMy WebLinkAbout06120021 Application
City of Carmel/ Clay Township Permit #:Of-, I;). OtJ.:2/
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Town Home, &. Two Family: New Structures, Additions, Remodels, &. Accessory Structures
BUILDER
OF
RECORD:
PROPERTY
OWNER:
STREET ADDRESS:
LOCATION
&. PROJECT
INFO:
LOT #:
c2
SUBDIVISION NAME:
,
NAME OF UTILITY ATION C NTRACTOR; PLAN COMMISSION / BZA I BPW DOCKET
NUMBERS; TAC DATE(S); AND/O COUNlY WELL AND/OR SEPTIC PERMIT #'5 (IF APPUCABLE):
;'01.5J ed
TYPE OF cONSTRUcnON: ~ TYPE OF MPROVEMENT:
.grSINGLE FAMILY pEW STRUCTURE
o TOWN HOME 0 ROOM ADDITION(S)
o TWO FAMILY 0 PORCH ADDmON(S)
# of units being 0 DECK ADDITION(S)
constructed at this 0 REMODEL
time: _ Basement Finish only
o RESIDENTIAL (For 0 ACCESSORY BUILDING
Additions. Remodels. Etc.) 0 DETACHED GARAGE
o ATTACHED GARAGr
o DEMOLmON
PROJECT INFORMATION:
Early Release
Permit:
Lot Split:
Manufactured
Trusses:
Sump Pump:
~~
Q N
~N
FAX:
Dio-c:t3/(j
ZIP:
0>
BEST METHOD OF CONTACT:
PHONE:
FAX:
cnY:
STATE:
ZIP:
SECTION:
/
ZONING:
oj
ESTIMATED COST OF CONST~'yCT10N:
ING LAND VALUE) '::f .
~# 601 aoOp.o
TAX MAP PARCEL #: ,"'",'. ~
I -Cfli-J:F-OCJ-_Q/";'
PLU~ING CONTRACT. o. R:<..i i
f IJlli!~ ,.
~rr ~% . ?nn5,1:'
Plumber's Indiana State1license #: ;' Ii
IJ i "'.-. -... _ . ' ., :
C-,- J Ocn{) /0 I .---.------._-1 ,j
-------
Which plumbing codes will be applie"Cfto'the construction:
o ~..[emational Residential Code wI Indiana -~~~~ents
o Uniform Plumbing Code w/lndiana Amendments
FOUNDATION TYPE: (Check all that apply for the new
constructionjJ~k..,.J""'A'u~t.<.J /~
o c!r{j\wLS~[(i~D -POST & BEAM PIER
o SLABEJ"'BASEMENT(WALKOUT: Y~
" -
For Single Famib:.lWsl I.Y{o..:fWlilY ,d.~lb.n~~~~lt:1fllflor accessory structures, this pennit is valid only if construction corrunences within 180
days of the datBJt~t:I~eIo\:Httrln~t?ahH'rhL\{~J~/n'l>leted (Certificate of Occupancy issued) within 18 months of the issuance date. Class I
structure pennQJtJ1l?Jdticm: ~~mtIGttA.'driUn.i~~~llliltiGmSte State of Indiana (See 675 lAC 12) regarding expiration time names for beginning and
. . of State and Local Code~. completing construction.
I, the undersigned, ;p~e that ~y constry~ti9~,..nrt.QLls}rB5ti...Ori.,n1J~nt, relocation, or alteration of a structure, or any change in the use of land or structures
requested by this 9lz1i1:'3ioOEi;! G,~iVH.'''(tk{ donf~r~5:'~~le laws oE the State of Indiana, and the "Zoning Ordinance of Carmel Indiana -1993" (Z'
289) and amen~~~er;kJli~tb.pnwpf~"'1 ef551~U.lsembly of the State of IndIana, and all Acts amendatory thereto I further certIfy that only
kitchen, bath, a~lfIoJr Mins'Mnb1\!'J~M"tb tn'e samtary~vJer: (tt;:tL.1r certlfy that the constructIon will not be used or occupied until a Certificate of
ell cyhas been issued by the De~kommurutY Semces, Carmel, IndIana
,. - 0-'.rlIC-P s'WIJkn'JU/;' 1:2 (6!OCa
Sig re of Owner or Authorized Agent -;~ x Date
OFFICE USE ONLY: **************************************************~* ***************************
INSPECTIO '" EQUIRED: Filing Fees: ZS / . tJ ()
Upper Foot' g Lower ~ootin Under Slab Base Inspections: ~771 )U
Cert of Occupancy::; 3. )1/
P.R.I.F.: / ::f (, /. 0 () Additional Fees
~;r#e:!:)~3 dO'
Fee Received by: Date
~
Reviewed/App Dept. of Community Services
S:Permits/Forms/ILP RESIDENTIAL
(Date)
# Charged Re-
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