HomeMy WebLinkAbout04120034 Application
City ofCarmel/C/ay Township Permit #: 01/1q03 If
COMMERCIAL or INSTITUTIONAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Commercial or Institutional: New Structures, Additions, Remodels, Tenant Finishes, & Accessory B~i1dings
,
BUILDER of
RECORD:
~~
STREET ADDRESS
CITY
STATE
ZIP
PROPERTY
OWNER:
BEST METliOD OF CONTACT:
.COrr) e- era...
FAA
- ~q~
STATE
'r5. ""TW
LOCATION
& PROJECT
INFO:
\ . \
Address of Shell Building (If different than Address 0
BUILDING. PROJECT. OR TENANT NAME:
-::r::.... \" \"" A (l\'\U-
STATE COMMEROAL SCOPE(S) OF 0 FDN 0 STR
DESIGN RELEASE #: 30 RELEASE: X ELEC 0 SPKLR
WATER UTIlllY SEWER UTIlllY
PROVIDER: Ifld i.Q.5\ 0\ \ ~ PROVIDER: C.-
PLAN COMMISSION / BZA / BPW DOCKET NUMBERS; AND/OR
COUNTY WELL AND/OR SEPTIC PERMIT #'S (If Applicable):
# of Roors: Elevator or Uft: 0 YES BLDG. CONSTRUCTION 1YPE:e:.)( OCCUPANCY CLASSIFICATION: 'R E(y)
TYPE OF CONSTRUCTION: /;'SZ TYPE OF IMPROVEMENT: PROJECT INFORMATION:
j8( COMMERCIAL 8"6' ~ NEW STRUCTURE Early Release Manufactured
(Prlvatelyownedhospttals l&Cf~'~t)~mON Permit: _Y LN Trusses: _Y VN
and medical officeS/centers ()~ 0 C ~,.-.,Room(s) ~
are commercial) 01 <::1:>.,. O/St. Q0.oQ'Y~. Lot Split: _Y ----.k::N Sump Pump: -Y ~
o IN~~'~~~I/PUbliC Bld9'l}- 0;:- O,l:-~~t. ~tpg~~Sf,Deck Does any part of the property lie within a special Flood
o School C-1 ~ FlN2tVCl; designation area: _Y----ILN
o Church AC DlllG /O~~UMBING CONTRACTOR:
FOUNDATION TYPE: (Checkallwhich AD^~' i:lE V~tiOI) \). \.
appl~r the new construction area) [~.J~€j.ijj5 t. ;S _~ I flS nO, (l
~ SLAB 0 CRAWL SPACE 0 C :$OW ~"Po Plumber's Indiana State License #:
o POST & BEAM 0 BASEMENT 0 CELL TOWER C - J'el
(or POST & PIER) WALKOUT:_Y_N 0 DEMOLmON '/,1:) <:.? 1'l~l" 0\4 \::d. "l",oC'...A
ZONING:
\i:)5
KARCH :w- MECH
OTHER(S):
ESI1MATED COST OF CONSTRUCTION:
(EXCLUDING lAND VALUE) .$ \
9o~
l)1o~
Class I structure pennits are subject to the General Administrative Rules of the State of Indiana (See 675 lAC 12) regarding 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 Cannellndiana - 1993" (Z'
289) and amendments, adopted under authority of I.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 occupied until a Certificate of
Occupancy or Substantial Completion has been issued by the Department of Community Services, Cannel, Indiana.
C-\a...y (hc..K
Print
\ ';;l-?;-Oy_
Date
OFFICEUSEONLY:************************************************************************
INSPECTIONS REQUIRED: Filing Fees: I 'P <is ?v
. . # Charged Re-
Upper F ting Lower Footing Under Slab Base Inspections: Reviews
Meter Base. @ Site ce.rt. of Occupancy: , 0 tJ _ /
) I TOTAL: it Q.. I 1'1 f.J I ~ 7-.. Additional Fees(
. . ("2-I()~ O+- ,,-1Au~f/ () Zt) ddtA - In- 12/Ji/OtJ-
unity Services (Date) Fee Recelved : ~ d - .