HomeMy WebLinkAbout06120105 Application
City of Cannel/Clay Township Permit #: D&/'). () I (J5;
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Town Home, & Two Family: New Structures, Additions, Remodels, & Accessory Structures
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BUILDER
OF
RECORD:
NAME:
BUILDER'S EMAll ADDRESS:
<:'"
PROPERTY
OWNER:
NAME:
STREET ADDRESS:
LOT #: <;170 SUBOIVISION NAMV
ADDRESS OF CONSTRucnON: I
2- - LI"'f\.Q1{1C.
SEWER UTILITY WATER UTILITY
PROVIDER: CT fI- fA.) () PROVIDER: CCL~ n-rd
NAME OF UTILITY EXCAVATION CONTRACTOR; PLAN COMMISSION / BZA / BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY-IVELL AND/OR SEPTIC PERMIT #'S (IF APPUCABLE):
/-(-.,\.
FLOOD ZONE AREA DESIGNATION. / ($)~~'~
FOR THIS PROPERTY: ~ ",\1 v/ \
/..... '1.\' <J
TYPE OF CONsTRurnoN: ~ '<.,
_..-:::::/".,,/ ~
LK SINGLE'FAMIL Y
o ' TOWNJ{OME 1- "
o TWO.. FA.tlIL Y ..d.. 0
# of,units ~
constrUcted at this
tinle:"%' .,./
o RESIO.ENTIAI:'(For
Additio'ns. Remod
'\\V
PROJECT INFORMATION:
LOCATION
& PROJECT
INFO:
STRUCTURE
RO ADDITION(S)
RCH ADDmON(S)
DECK ADDITION(S)
REMODEL
_ Basement Finish only
o ACCESSORY BUILDING
o DETACHED GARAGE
o ATTACHED GARAGE
o DEMOLmON
Early Release
Permit:
Lot Split:
Manufactured
Trusses;
Sump Pu'!'p:
~N
t/Y =N
_Y
PHONE:
'I) () ()
FAX'
, J'Y/-YZ-2 y
f' 'I i-
STATE:
ZIP:
2...1"0
BEST METHOD OF CONTACT:
Co E--frtvr ~/
FAX:
CITY:
STATE:
ZIP:
WO./-C%;.ON 6f16'2.,
ZONING:
<>
rl-
'I
SQUARE
FOOTAGE:
1'i~J
va
quo. -
-(.I J(
TAX MAP PARCEL #:
l~,
Which plumbing codes will be applied to the construction: '"- ~
~emational Residential Code w/Indiana Amendm~
o Uniform Plumbing Code wI Indiana Amendments
FOUNDATION TYPE: (Check all that apply for the new
construction area)
o CRAWLSPACE 0 POST & BEAM PIER
Gl-'SLAB GY1lASEMENT (WALKOUT:_Y .;/N)
For Single Family and T w~,ijy '.' ~& lJdditions, remodels, and/or accessory structures, this pennit is valid only if construction commences within 180
days of the date of issuance -;'l'iHfb\'\!J-~$ pt'~f?7J4 must be completed (Certificate of Occupancy issued) within 18 months of the issuance date. Class I
structure permits are sul!f.s:-! to tluiS~D,ernI~lsl'ra@~ks of the State of Indiana (See 675 lAC 12) regarding expiration time frames for beginning and
t::.P.,. ~1~ltD. - nCf;J w' rRprnPk..tingconstruction.
I, the undersigned, ag~Fl c,.O;;,;;i'~~ fK1~f\!cti{!t9. ~~e'T~~~on, or alteration of a structure, or any change in the use of land or structures
requested by this application wW'P;~5i~ ~w1i21 ,;4I$d lJ9nfOfrii't~Al2plitt1J1;u.~~!M the State of Indiana, and the "Zoning Ordinance of Carmel Indiana -1993" (Z'
289) and amendments, adopted unde . Q( r.~3a;7~'k ~ral AS'l~ of the State of Indiana, and all Acts amendatory thereto. I further certify that only
kitchen, bath, and floor drains are connected to lle ~:rftt:1ry:slwO'l:!p er certify! that the construction will not be used or occupied until a Certificate of
Occupancy;as ~en i~sued ,,-the Depar~)f:;offHnt4d7t5M el,;Indiana.
~. N..q WN.. (. ?;rO t _ /L-2./-~ "
Signature of OWner or Authori Agent' pr' t Date
OFFICE USE ONLY: **************************************** ********=1* *****~**** * ***************
INSPECTIONS REQUIRED: FIling Fees: IJ! 50
Base Inspections: d -11. <7)
-
Cert. of Occupancy:
Under Slab
Site
P.R.LF.:
(Dale)
# Charged Re.
Reviews
Additional Fees