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City of Carmell Clay Township Permit #:
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, &. Two Family: New Structures, Additions, Remodels, &. Accessory Structures
BUILDER of
RECORD:
NAME
PHONE
FAX
g '11J~ ~f/7
t= Ie! E
g Lj{,- 5;) ~7
STREET ADDRESS
..7 5>1
w.
ZIP
~o33
BUILDER'S EMAlL ADDRESS
PROPERTY
OWNER:
NAM~/
STREET ADDRESS
/3lf/o
pC;;
#~
FAX
571- 8'jg
STATE
fA/'
ZIP
7't:> (J 3 :J-
J
CITY
~,flf Mt: L.
LOCATION
&. PROJECT
INFO:
~~~~LITY 'sapo:) I O~~~CONSTRUCTION: Jt
F..;.~' ."",,j , . LUE) -;; 5- p &> i!J
NAME OF LmLITY EXCAVATION CONTRACTOR; PLAN COMMISSION I BZA I BR'IVIl~Ul.SN.O'"' uo. :l 03S""' . _..h.~""';' ~
NUMBERS;TACDATE(S);AND/ORCOUNlYWELLAND/ORSEPTICPERMrr#'5~IF'AtlPH~i., _. '-~'Cl_ V:1 ~tf'-, " ,
\\ r:.~., /,.- ,- i~' -'.. N~ ~
TYPE OF IMPROVEMENT: ,jPLUMBINGcc'ONTRACTOR:'~ <L.> ~ .
t' (I ., ,
o NEW STRUCTURE II~ II :1/ i i
lit' ROOM ADDmON(S) IL'11 I!Plu ~tate License #:
o PORCH ADDmON(S) I c' ! ' : Ii;:
..-r-./ I iJl.jJ!
LV REMODEL J .~."-'- __J I
o ACCESSORY BUILDING Which plumbing codes will be .ppIl~ to the con....uction:
o DETACHED GARAGE --O-iiitematlonaIResidentiaI.C6.te w/lndiana Amendments
o ATTACHED GARAGE. .
o DEMOLmON 0 Un.fonn Plumbing Code w/lndlana Amendments
(Multi-Family Construction Code)
Manufactured FOUNDATION TYPE:
construction area)
_Y _N Trusses: _Y _N
o CRAWt5PACE
Lot Split: _Y _N Sump Pump: _Y _N 0"'5LAB
Does any part of the property lie within a special Flood designation area: _Y_N
LOT #
.3
TYPE OF CONSTRUCTION:
o SINGLE FAMILY
o TOWN HOME
o TWO FAMILY
# of units:
,Q;:;-~ULTI-FAMILY
/' # of Units:
/ ~ REsIDENTIAL (For
. L./Additions, Remodels, Etc.)
PROJECT INFORMATION:
Early Release
Permit:
SECTION
zqNiN.C:
(CU".
,:t:i..'
1 AVlO 113~l:lV'O =10 AlI~
SQUARE
FOOTAGE:
/,;fQ 4
(Check all that apply for the new
o POST & BEAM
o BASEMENT
WALKOur:_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) withhi 18~ months of the
issuance date. Class I structure permits are subject to the General Administrative Rules of the State of Indiana (See 675 lAC 12) regaroing expiration
time frames for beginning and completing construction.
I, the undersigned, agree that any construction, 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 Carmel
Indiana -1993''' (Z;289) and amendments, adopted under authOrity of l.c. 36;7 et seq, General Assembly of the State of Indiana, and all Acts amendatory
thereto. I further certify that only kitchen, bath, and floor drains are connected to the sanitary sewer. I further certify that the construction will not be
used or oc pied until a Certificate of Occupancy has been issued by the Department of Community Services, Carmel, Indiana.
( '//;4-/ ,F/i'e/c/E
Print
D.~/t~/O :7
OFFICEUSEONLY:**********************************************"11**~*******************
Filing Fees: / Yf'L c.j()
INSPECTIONS REQUIRED: ' .
-- Base Inspections: ;J'd- ';) O(J # Charged Re-
Upper Footing Lower Footing Under Slab ...-If ReVlews
Cert, of Occupancy: )"'5. bY
Rough In
W Ji_ ff!Ji
Reviewed/Approved: Dept. of Community Services
:---. S:Permlts/FormS/ILP RESIDENTIAL
~,
Meter Base
inal
Site
Additional Fees
P.R.I.F.:
~
tJ
(Date)
Fee Received by:
i.I,-o/. <V(.~.