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C't ifc l/CI 'T' h' Permit #: () 7 tJ .3' 000'-/
t Y 0 arme ay .l owns tp
COMMERCIAL/INSTITUTIONAL/MUL TI-F AMIL Y IMPROVEMENT LOCATION PERMIT
APPLICATION (For New Structures, Additions, Remodels, Tenant Finishes, & Accessory Buildings)
BUILDER
OF
RECORD:
NAME: ; f
nC/o.r
STREET ADDRESS:
PHONE:
g t): 3'
FAX:
~l2-3%-:J..OS't
CITY:
STATE: ZIP:
~\
.:r
72(",5"
BUILDER'S EMAIL ADDRESS:
"
ArrAuN CoNs
BEST METHOD OF CONTACf:
~ C. 0 ('V\
PROPERTY
OWNER:
NAME:
C.L
PHONE:
FAX:
<.;
CITY:
Co.r 1'1'0<:''-
STATE:
:r:.A/ 0
ZIP:
STREET ADDRESS:
LOCATI<;)N
& PROJECT
INFO:
ADDRESS OF CONSTRUcnON:
1\ -, 00 N c nDI-A $\
Address of Shell Building: (If dIfferent than Address of Construction)
BUILDING, PROJECT, OR TENANT NAME:
Ca CaT
STATE COMMERCIAL
DESIGN RELEASE #: '3
WATER lJTILITY
PROVIDER: CV\ -r tv' ~ \..
SCOPE{S) OF 0 FDN 0 STR
RELEASE: J< ELEC ~ SPKLR
SEWER lfTIlffY
PROVIDER:
~ MECH '!(
757
ESTIMATED COST OF CONSTRUCTION:
(EXCLUDING LAND VALUE) . '\
, eo<=>
PLAN COMMISSION I BZA I BPW DOCKET NUMBERS; AND/OR
COUNTY WELL AND/OR SEPTIC PERMIT #'S (If Applicable):
# of Floors: Elevator or Uti:: ~ES Q NO BLDG. CONSTRUCTION TYPE: I-A )<.. OCCUPANCY CLASSIFICATION: ~
TYPE OF CONSTRUCTION: TYPE OF IMPROVEMENT: PROJECT INFORMATION:
~ COMMERCIAL 0 NEW STRUCTURE Early Release
(Privately owned hospitals and medical 0 ADDmON Permit: _y ~N
offices/centers are commerdal) 0 ~<\m(s)
o INSTITUTIONAL \J<p"\41~i'!h Lot Split: _Y..J(,-N
o Munlopal/Public Blllfh CONSi? .,p,\\l'l~nme or Deck
o Sc~~^ SED FU'" ;t\1IiilI"li~i5DEL FLOOD ZONE AREA DESIGNATIONrSl FOR THIS PROPERTY:
DBIli~ O(t1p\""f\CB"'\ \(~lNEW~iFINISH \~ h d ~
o MULTI~Ml\\l'(;\ to C te af\d LC'C<l r;5C;'At;:cESSeR IJJLDING )( - !.LV) Q. ;::l ~/X
NumbeYofumts:f\\S\8., "M\_)i'''\\\(!Y15EJA~ ~GE .
, ",-,n,; ~,UW" CI.J;:;J' 'AmtHED GARAGE PLUMBING CONTRACTOR:
FOUNDATION yUf:l'({;IleCk ~'8'({/'tC~ I 0 CELL TOWER (New)
apPIYforthenCW~&htar<;~~OIf>-NI5 CELL TOWER CO-LOCATE Ll;.Ac:..", - ~u~S~LL
o SLAB 0 CRAWL sllA'cE) 0 DEMOLITION Plumber's Indiana State License #:
o POST&_BEAM _PIER 9Q. BASEMENT (WALKOIJT:_Y_N)
Manufactured
Trusses:
Sump Pump:
_Y..15....N
_Y~N
ii-- ?\ G5 ooo~6
Class I structure permits are subject to the Genetal Administrative Rules of the State of Indiana (See 675 lAC 12) regarding expiration time frames for beginning and
completing coustruction.
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 Cannel Indiana - 1993M (Z-289) and amendments,
adopted under authority 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 floor drains are
connected to the sanitary sewer. I further cettify that the construction will not be used or occupied until a Certificate of Occupancy or Substantial Completion has been
issued by the Department of Community Services, Carmel, Indiana.
I( A", ~ALl
L-. i U-5 -(
I/L707
Dote
Print
OFFICEUSEONLY:************************************************************************
INSPECTIONS REQUIRED: C Filing Fees: J./ ~fe , '6..s
Lower Footing Under Slab 3/7 Base Inspections: ;{ 00 . 00
Cert of Occupancy: / d 7, C> .-0
tfS~,'i5-3
Revlewed/A proved: Dept. of Community Services
S:Permitsjform LP COMMERCIAL
,2007