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City of Carmel/Clay Township Permit #1)7#36/;3
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Town Home, &. Two Family: New Structures, Additions, Remodels, &. Accessory Structures
I
BUILDER
OF
RECORD:
PHONE: FAX:
'Ol 6 - O~<:O
CITY: STATE: ZIP:
W. b-z./Cl<.lSUI
BEST METHOD OF CONTACT:
Q<!l>L. co.}-1 PtbNC:
BUILDER'S EMAIl ADDRESS:
I aLl c.
PROPERTY
OWNER:
NAME:
'7W
PHONE:
2:2.8 -01 '5
FAX:
'2.~ - 0"2.07,
CITY:
C(Q).1.;lSV,
SUBDIVISION NAME: 1/'
b eL<..EWOa~
STATE:
.:rr-.l
SECTION:
ZIP:
4~07 :
STREET ADDRESS:
41:, rcnWE.,>r
LOCATION
&. PROJECT
INFO:
LOT #:
ADDRESS OF CONSTRUCTION:
1"0 8 .M''':K L-A.J.
SEWER UTILITYC'l-4-'{ ,-o.;.>USi+1 E' WATER UTILITY 0
PROVIDER: ~/OiJ6..L- oJ" "-TC PROVIDER: G41Z-4
NAME OF UTILITY EXCAVATION CONTRACTOR; PLAN COMMISSION / BZA / BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'S (IF APPUCABLE):
FLOOD ZONE AREA DESIGNATION(S)
FOR THIS PROPERlY:
X W15~ adetL
TYPE OF CONSTRUCTION:
N SINGLE FAMILY
&TOWN HOME
o TWO FAMILY
# of units being
constructed at this
time:
o RESIDENTIAL (For
Additions. Remodels. Etc.)
TYPE OF IMPROVEMENT:
~ NEW STRUCTURE
o ROOM ADDITION(S)
o PORCH ADDmON(S)
o DECK ADDITION(S)
o REMODEL
_ Basement Finish only
o ACCESSORY BUILDING
o DETACHED GARAGE
o ATTACHED GARAGE
o DEMOLmON
INSPECTIONS REQUIRED:
~per F~ Under Slab
Meter Base nal
P.R.LF.:
-'2.
Reviewed/Ap roved: Dept. of Community Services
S:Permits/FormS/IlP RESIDENTIAL
'-
i::;x:CJ>. t>. ).J <3
TAX MAP PARCEL;#":
.(i
< ,
r-\;/
PL BING CONTRACtOR: MAR 2 3 2007
W 'I' '" LI,,:lL .
t+I-r-INi\'FR;,~T'1 E.
Or:Jumber's Indiana Sta~2ense #: .
rG , 0 ClO 6 .~ -.-
: !
-f In
" I"
,.1, _,i
iLLJ)1
, I
I
I
1
Which plumbing codes will be applied
~ International Residential Code w/Indiana Amendments
o Uniform Plumbing Code w/Indiana Amendments
*****************************************
/ /6? dO
'd;2-'17 S()
,53 sO
1,2 6/, If d Additional Fees
TOTAL: # ;l7J1.do
# Charged Re-
ReViews
Fee Received by:
Date