HomeMy WebLinkAbout06120002 Application
City of Carmel/Clay Township Permit #: 0 ~ I?L>OO"Q..
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Town Home, &. Two Family: New Structures, Additions, Remodels, &. Accessory Structures
STREET ADDRESS: Z
BUILDER'S EMAIL ADDRESS: 'S
NAME:
BUILDER
OF
RECORD:
NAME:
PROPERTY
OWNER:
STREET ADDRESS:
(/
1,0 '4&0 ':J
B40r
PHONE:
FAX:
CITY:
STATE:
ZIP:
LOCATION
&. PROJECT
INFO:
LOT#:
ADDRESS
SUBDIVISION NAME:
ZONING: ~
~g~~~E: 7 q04
~~~~6i~G C3.~o":A~~~)~~~~~~~_~~~~ tJa)~
1,_' --, I>~' \i :J.' . U \::
u8J~i )fI>'c.'.::~::C '- ---
'I ~ I
TAX MAP PAIII! n D EC - 1 2006
III II' !~~l
PLUMBING CONTRACTO~l-_I___..J. i
I ~rveu-\ J
Plumber's Indiana Smfeucense #: - --
ILl 00108
SEWER UTILITY ~ WATER UTIUTY AJ I
PROVIDER: 0 WD PROVIDER: CCtA/lIt.L.1
NAME OF UTILITY EXCAVATION CONTRACTOR; PLAN COMMISSION! BZA! BPW DOCKE1C:U
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'5 (IF APPUCABLE):
FLOOD ZONE AREA DESIGNATION(S)
FOR THIS PROPERTY:
TYPE OF CONSTRUCTION:
iXl'D SINGLE FAMILY
h TOWN HOME
o TWO FAMILY
# of units being
constructed at this
time:
o RESIDENTIAL (For
Additions. Remodels. Etc.)
h~
Pill:
'.' Iii
, . ~ i!
fG(
Which plumbing codes will be applied to the construction:
~Intemational Residential Code w/Indiana Amendments
o Uniform Plumbing Code w/Indiana Amendments
FOUNDATION TYPE: (Check all that apply for the new
construction area)
PROJECT INFORMATION:
Early Release ~ ManutacturedO"" X
Permit: _Y.':::::::'N Ass~Gl~ I\~y _N 0 CRAWLSPACE 0 POST& BEAM_PIER
Lot Split: _Y ~ G~~~f~oIa\iO~y _N 0 SLAB ~ BASEMENT (WALKOUT:_y-2(N )
For Singles ~~~f~~, )1~' :n:.\8dJor accessory structures, this permit is valid only if construction commences within 180
days of t attstGa'ii~~'"t~bt1.i'rdqj:g;~~~d" ~~pleted (Certificate of Occupancy issued) within 18 months of the issuance date. Class I
structure p are ~~t~<<~\~~'a1\.\:~€J"W~llUles of !:lie State of Indiana (See 675 lAC 12) regarding expiration time frames for beginning and
; nf CUY" I G~' . completing construction.
I. the undersi~951ee"th'iu ~~boIkfts.onstruction, enlargement, relocation, or alteration of a structure, or any change in the use of land or structures
requested by tHrt' ~lf~\totGJi'l'l'c'"omiJ.V\\\~\a"f(rconform to, all applicable laws of the State of Indiana, and the ~Zoning Ordinance of Cannel Indiana - 1993n (Z'
289) and ameG\:\n'-s,Ydopte~ ~nder~'hority of LC 36,7 et seq, General Assembly of the State of Indiana, and all Acts amendatory thereto. I further certify that only
kitchen, bath, and fIoo ins are co ec d to the sanitary sewer. I further certify that the construction will not be used or occupied until a Certificate of
Occupancyhas ed. th e artmentolcorrunUnityservicep~;;aL ;./OVt/sl: I' .arC.. /0 (9
Signature of Print Date
TYPE OF IMPROVEMENT:
~ NEW STRUCTURE
o ROOM ADDITION(S)
o PORCH ADDmON(S)
o DECK ADDmON(S)
o REMODEL
_ Basement Finish only
o ACCESSORY BUILDING
o DETACHED GARAGE
o ATTACHED GARAGE
o DEMOLITION
# Charged Re-
ReViews
Cert. of Occupancy:
P.R.I.F.:
~/'"J '
;d/ Appro e ept. of Community Services
JFormS/ILP RESIDENTIAL
,
j
Additional Fees
------
\.4