HomeMy WebLinkAbout06120024 Application
NAME OF UTI EXCAVATION CONTRACTOR; PLAN COMMISSION / / BPW OOCKET
NUMBERS; TAC OATE(S); ANO/OR COUNTY WELL AND/OR SEPTIC PERMIT #'5 (IF APPLICABLE):
BUILDER
OF
RECORD:
PROPERTY
OWNER:
LOCATION
& PROJECT
INFO:
SEWER lITlLITY
PROVIOER:
City of Carmel/Clay Township Permit #:010 J :J..DD25
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Town Home, & Two Family: New Structures, Additions, Remodels, & Accessory Structures
,
NAME:
PHONE:
FAX:
STREET ADDRESS:
7. ;<0 f':,.."
BUILDER'S EMAIl ADDRESS:
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NAME:
"T
STATE:
ZIP:
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BEST METHOD OF CONTACT:_
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PHONE:
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CITY:
FAX:
3'
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ZIP:
T"-
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STREET ADDRESS:
STATE:
LOT #:
SECTION:
ZONING:
SUBDIVISION NAME:
N (>..
ADDRESS OF CONSTRUCTION:
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B6C
SQUARE
FOOTAGE:
ESTIMATED COST OF/CONSTRUCTION:
(EXCLUDING lAND VALUE)
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"I:
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FLOOD ZONE AREA DESIGNATION(S)
FOR THIS PROPERTY:
TYPE OF CONSTRUCTION: TYPE OF IMPROVEMENT:
o SINGLE FAMILY ~ N'!i~URE
o TOWN HOME .,mlRo6M D~ION(S)
o TWO FAMILY ....D ~O? CO'~Q \P~L 'jjbmON(S)
# 2!l"litl )J,€tI/1 ' . ance "'1'\0'" ~ ADDITION(S)
cO~diB~s>\l\l \ oc~CRE~8E.S
tims>\b\eCt . State ano - ",I'( S\:::B.l's~~f1nish only
o RESIDENTIAL {i'llr rn~fMIU\ 10 .J\€,cgs,5DIl.VllUILDING
AdditiO~@i1,;,.gC.l_\.. I CIoXDETACHED GARAGE
Of Cp..?N\t: C' \N~ ATTACHED GARAGE
PROJEC1~j~RMATION: \NiJ 'r DEMOLmON
Early Release I ___ Manufactured
Permit: ~y ~N /~frUS5es:
Lot Split: _Y _LW Sump Pump:
i
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PLUMBING CONTRACTOR:
,.4/ "'-
Plumber's Indiana State License #:
-0. -
o
NIb..
Which plumbing codes will be applied to the construction:
o
o
International Residential Code wI Indiana Amendments
Uniform Plumbing Code wjlndiana Amendments
u
Y N.
Y~/-
FOUNDATION TYPE: (Check all that apply for the new
construction area)
o CRAWLSPACE 0 POST & _ 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 permit, 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.
It the undersigned, agree chac any construccion, 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 Cannel 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, oor drains are connected to the sanitary sewer. I further certify thai the construction will not be used or occupied until a Certifica.te of
Occupancy e ssued by the Department of Conununity Services. Cannel, Indiana.
~flf~;(} A.dMI}e...l.f
Print
If /oa/~(p
Date
ignature of OWner or Authorized Agent
OFFICE USE ONLY: ****************************************************** ***************************
Filing Fees:
Upper Footing
Rough In
INSPECTIONS REQUIRED:
Lower Footing Under Slab
Meter Base Final @
Base Inspections:
Cert. of OccLIpancy:
J\
Reviewed/Appro ed: Dept. of Community Services
S;Permits/FormsjlLP RESIDENTIAL
\
(Dale)
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