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City of Carmel/Clay Township Permit #:011)'2..0 J.3J..f
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, & Two Family: New Structures, Additions, Remodels, & Accessory Structures
BUILDER of
RECORD:
CUA'lnC' /
STATE
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ZIP
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NAME
FAX
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PROPERTY
OWNER:
PHONE
FAX
CITY
STATE
ZIP
LOCATION
& PROJECT
INFO:
LOT #02(0
SECITON
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ZONING~ _I
SQUARE . /
FOOTAGE' smy
E q.51-
TYPE OF CONSTRUCTION:
~ SINGLE FAMILY
tJ TOWN HOME
o TWO FAMILY
# of units:
o MULTI-FAMILY
# of Units:
o RESIDENTIAL (For
Additions, Remodels, Etc.)
ESTIMATED COST OF CONSTRUCTION, '),..,.,
(EXCLUDING LAND VALUE) o,LVO( 000
I
NAME OF UTILITY EXCAVA N CONTRACTOR; PLAN COMMISSION I BZA I BPW DOCKET 11 o:!tJ:2.01
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT ,'S (IF APPUCABLE), LJ F' B
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PLUMBING CONTRACTOR: . .... J '
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Plumber's Indiana State license #:
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SEWER UTILITY
PROVIDER,
Which 'p'lumbing codes will be applied to the construction:
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~Intemational Residential Code wI Indiana Amendments
.ri~l"
-0 Uniform Plumbing Code wI Indiana Amendments
," \. (Multi-Family Construction Code)
PROJECT INFORMATION:
Early Release
Permit:
Manufactured FOUNDATION TYPE: (Check all that applY,for the new
_Y \t1 N Trusses: 1y _N construction areal. ...&!.'f,.'....
-+:- 0 CRAWLSPACE 0 !'~~,:,"
Lot Split: _Y ~N Sump Pump: jQy _N 0 SLAB., ;"_;;;,~~~~
Does any part of the property lie within a special Flood designation area: ----:-iY:" ':~~~~i~~oih: ~:( 1N
Fo~ Si~gle Family and Two Fa~ily dwellings, ad~iti?ns, remodels, and/or accessory ,SF].cH,.ll} ~~~!.M'--::'.' '.l~~ri~.~',~_ ""'~.' :"~.' t' , ommences
. WIthm 180 days of the date of lssua~ce of the ,buddmg permit, and must be compJ..eav~~fi'4~\?!"~~~'~!\SX\~ ~'.' . ',:, m?nths o~ th~
Issuance date. Class I structure permIts are sub~ect to the General.Ad.ministrative ft\~i"~(p~~~~ln. d,i.,. ,~.~.j~l!e.~~f.\.lI:.'..l,_".,:,~'regardmg expIration
time frames for begmmng and compl$Q)tt"'on~tT.UcJJ:~.G;)~\.-'., \ CW;:; ,', :;, ~'J.'
I, the undersigned, agree that any construction, reconstruction, enlargement, relocation, or al~.. .. (9._~~i"s{ '- I _ ~. ~.'.\QN.. _ _~nge';.inlt?e US~ of land or
structures requested by this application \\ill comply with, and conform to, all applicable ]a\~~~~}~t. n i~'i)~t"ZoningOrdfuance of Carmel
Indiana - 199r (Z~ 289) and amendments, adopted under authority of LC. 36~7 ct seq, Gcncr~~e~""'y 0 the Sta~~'of ltl'diana:'and all Acts amendatory
thereto. I further certify that only kitchen, bath, and floor drains are connected to the sanit~wer. I further cer'tify rha.t.the construction will not be
us occupied til a Certificate of Occup cy has been issued by the epartme of Community Services, Carmel, Indiana.
c/-;Jo-cn
Date
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Final
Site
P.R.I.F.:
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;217 ::() .J arged Re-
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Additional Fees
ower Footing
Filing Fees:
Base Inspections:
Cert. of Occupancy:
INSPECTIONS REQUIRED:
b
Fee Received by: