HomeMy WebLinkAbout07030017 Application
City of Carmel! Clay Township Permit #07~ 3 CfJ! 't
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Town Home, &. Two Family: New Structures, Additions, Remodels, &. Accessory Structures
.
BUILDER NAME: K~>,j 8CJsci--/t3E PHONE: FAX:
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OF
RECORD: STREET ADDRESS: CP3:;:ii:;w/~'-t"{2-J OtC-EH:Y:~ STATE: ..::::z;;; ZIP:
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, / .j BEST MErnOD O~~: c.~<. €-
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PROPERTY NAME: PHONE: FAX:
OWNER: $17 r7J ';.b; . ~ ,
STREET ADDRESS: CITY: STATE: ZIP:
LOCATION LOT ':'-14' rfj~~~~Ml:sfff;€f SEcnON: ZON~i!i ?
&. PROJECT ''''7_' .
INFO: ADDRESSOFCONSTRUCTION:977 WrJ /J"G.J ;;J.,t:IlJC SQUARE '. .,.--
FOOTAGEt$~~: .7
SEWER UTILITY /VJ ,q I WATER UTILITY /Y'/rI EST1MATED COST OF CONSTRUlDlON: ~ _ 'L
PROVIDER: PROVIDER: (EXCLUDING LAN~ V~\LU~);~~:. " .' . -J , ~
NAME OF UTIUTY EXCAVATION CONTRACTOR; PLAN COMMISSION I BZA I BPW DOCKET ~/8 " " "7,'Y/- tfv C/ . cc
NUMBERS; TAC DATE(S); AND/OR COUN1Y WELL AND/OR SEPTIC PERMIT ,'5 (IF APPUCABLE): il; .......... "'J/
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"v /19 ~ , r- '. ; : : ':1
FLOOD ZONE AREA DESIGNATION(S) TAX M~~ rA.~CEL 'MAR - 1 2007 iil
FOR THIS PROPERTY: ! i I ~:- I'!
FOUNDATION TYPE: (Check all that apply for the new
construction area)
o CRAWLSPACE 0 POST&~~M_PIER
o SLAB Gl--BliSEMENT ~~ofo.9 Y_N)
~ ,\\y.
For Smgle Family and Two Family dwellings. addItIOns, remodels, and/or accessory structures, this pennit IS valid 0 ~CtIorr)i:O ~ ISO
days of the date of Issuance of the bUlldmg penmt, and must be completed (CertIficate of Occupancy Issued) ~ RIOnthS'~~' - ~A~\l:lass I
structure pemuts are subject to the General AdministratIve Rules of the State of Indiana (See 675 lAC 12).J.~~s~piI~n\.1me~"e~innmg and
completmgconstructlon b..'Ov ~\:-\( \~ \..: -w.\\' ::5.Q.
I, the underSigned, agree that any construction, reconstructIon, enlargement, relocation, or alterat:~~hl~:~r ~~~~~the.. ut~f land or structures
requested by thiS application WIll comply with, and conform to, all applicable laws of the State of I ~~\fie ~~fif~;'~Ji!anc\~~el Indiana - 1993n (Z'
289) and amendments, adopted under authority of I C 36,7 et seq, General Assembly of the State of I~ a~d RiM~~~~~:"I further certify that only
kitchen, bath, and floor drams are connected to the samtary sewer I further certify that the construction ~&t)je ~~'oc until a Certificate of
Occup'Wcyh.. en."ue 'heDepartrnen,ofCOmmUrn,yse""m.w,an8t1 Sc ~~<( c.r '\ ;;t./;;Z-;/o7
Signa .re of Owner or Authorized Agent Print ,~ Date
OFFICE USE ONLY: ************* ********************************************************************
F'!' F . ~)o fl 70
INSPECTIONS REQUIRED: I Ing ees. ,y -'
. . Base Inspections: / / /, 0 ()
Upper Footmg lower Footmg Under Slab ____{)
Cert. of Occupancy: S 3...:>
TYPE OF CONSTRUCTION:
o SINGLE FAMILY
o TOWN HOME
o TWO FAMILY
# of units being
constructed at this
time:
)l( RESIDENTIAL (For
Additions. Remodels, Etc.)
TYPE OF IMPROVEMENT:
o NEW STRUCTURE
~ ROOM ADDITION(S)
o PORCH ADDITION(S) ~
o DECK ADDITION(S) (11'/
;8( REMODEL /'
_ Basement Finish on
o ACCESSORY BUILD ./
o DETACHED GA E..t
o ATTACHED G GfiJ"-
.' PROJECT INFORMATIOJ!: /' ~ DEMOUTIO QY
Early Release /y,Manufactured V
Permit: Y N Trusses: Y . N
Lot Split: Y = Sump Pump: Y ~
~
final SlW
--
Meter Base
PLUMBING CONTRACTOR:" ...._.._~.j-,.. j
L._._....mm~/I} J
Plumber's Indiana State License #:
Which plumbing codes will be applied to the construction:
o International Residential Code wI Indiana Amendments
o Uniform Plumbing Code w/Indian. Amendments
# Charged Re.
ReViews
Additional Fees
Ca..,
Reviewed/Ap roved: Dept. of Community Services
S:PermltsjFormsjILP RESIDENTIAL
P.R.I.F.:
I _' TO:;AL: ~ 3~o
~>fJtft@}G A '1.'
Fee Recelved~bY: ~
(Date)
Date