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Application for vJ~G Permit No. ot{ I). 40(P3
Improvement Location Permit Date .1'2/'1),,4
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This permit is valid only if construction is started within 180 days of the date of issuance for residential construction; and for commercial projects, within one (1)
ear of the date of issuance of the State Commercial Desi Release. All construction must he com leted c/o issued within 2 ears of the issuance date.
NAME
PHONE
FAX
BUILDER
962 -ortXJ
STATE ZIP
fY? '2-
PROPERTY
OWNER
NAME
e.fLI~ ~€(?t7
PHONE
FAX
. &'1,?(p
.LV .A
LOT
SUBDIVISION
SECTION
?
ZIP
STREET
CITY
10
c.A1ZM
LOCATION
1-~1
ADDRESS OF CONSTRUCTION
,JJ '-+ 0
A. TYPE OF CONSTRUCTION Do plans include a porch? F. TYPE OF IMPROVEMENT / / X /"7"-
1. lit Single Family 0 Yes I>rNo I 0 New
2. 0 Two Family 2 JOY Ad ~o.; ~
3. 0 Multi-Family l of Foundation 3 iii" Re onnnerCla a
5. 0 OTHER 0 Basement (Wal~out Y, N ) '. 0 De DEe - 9 2004
(Specify) 0 Slab "'ttJi) 6. 0 Acc uilding
B. SEWE~: ~ J/;U/~(A 7. 0 Gar e
1. ~ Public (Name of system ~!;;:L ) (f!Jr:V- <J,.- . r
2. 0 Private(Countypermit# ) ~& Lot Split
c. W A TEft: 62- H. Flood Zones YES NO ,,/
1. [l( Public (Nameofsyste ), .$.IJQmPump YES _ NO~
2. 0 Private (County permi i:: N TR':fJC IYlaIDlfactured Trusses YES _ NO ~
. Su ra:t to comp Ii" 11 regulations -
D. ZONING: Jd - .~ S\ate and ,dSde!llumbing Contractor ~1./=!1l...1l'l!bG?
E. ESTIMATED COST OF t6rOIER1II'<Ora!l0M ITV SEift.'(j~ing Code: 0 Plumber's ~.
(Excluding Land Value) ~ 1~tG!f CAi=lMi=1 / CLAY T~~llHnbing Code: Ii' License #: . I
***************************** ************I~~r)\~j(****************************************************
I, the undersigned, agree that any construction, reconstruction, e~argement, relocation, or alteration of a structure, or any change in the use ofland or structures
requested by this application will comply with, and conform to, all applicable laws of the State ofIndiana, and the "Zoning Ordinance of Carmel Indiana- 1993"
(Z-289) and amendments, adopted under authority ofLe. 36-7 et seq, General Assembly of the State ofIndiana, and all Acts amendatory thereto. I further
certify that only kitchen, bath, and floor drains are connected to the s~it!!!Y. sewer. I further certify that the construction will not be used or occupied until a
Certifiea 0 e pane has bee issued by the Department'orComm~ ervices, Carmel, Indiana.
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er)
E-Mail:
/(190 ~"--@ /19111 ~lh()1lt~-
Filing Fees:
Base Inspections:
Cer!. of Occupancy:
# Charged Re'.
Reviews
P.RJ.F.: //
I // .. TOTAL:
" A" /1 1#;1'/1'1;;/ #
~ (~:~e~~~0~-U4?
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Plan COmmiSSiOnJBZAJBP.~ ~ocr;'Jl TAC Date(s)
Wdf_. (~
Reviewed/Approved: Dept. ofConnnunity Services
S:PermitslFonns/ILP3-04