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City of Carmel/Clay Township Permit #:07{)~ODroq
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Town Home, &. Two Family: New Structures, Additions, Remodels, &. Accessory Structures
OFFICE USE ONLY: *** **** * * * * * * ** * * ** * * * * * * * * * * * ~~ ***** * ** * * * * * ** * * it** """1 if, * l! lJ * * * * * *** ** * * * * * * *
INSPE EQUIRED: FIling Fees: !f?- ~ . .
per Footin Under Slab Base Inspections: :$ ~ ~~ :Jj;
~ Cert. of Occupancy:
(Roug-o/(Meter Base D Final Site / ..., i_I. 00
~. P.R.I.F.: e><.t:J
~~
BUILDER
OF
RECORD:
wefW
men fond @ r
BUILDER'S EMAIl ADDRESS:
PROPERTY
OWNER:
NAME:
STREET ADDRESS:
LOCATION LOT #: SUBDIVISION NAME:
&. PROJECT
INFO: ADDRESS OF CONSTRUcnON: 3'-/W
SEWER UTIUTY WATER UTIUTY A .{\,1/VV1 4 A
PROVIDER: PROVIDER: LJJ' fILLY
NAME OF UTILITY EXCAVATION CONTRACTOR; PLAN COMMISSION / BZA / BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'5 (IF APPLICABLE):
FLOOD ZONE AREA DESIGNATION(S)
FOR THIS PROPERTY:
TYPE OF CONSTRUCTION:
.x SINGLE FAMILY
o TOWN HOME
o TWO FAMILY
# of units being
constructed at this
time:
o RESIDENTIAL (For
Additions. Remodels. Etc.)
TYPE OF IMPROVEMENT:
~EW 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 DEMOLITION
S;Permits!FormS/llP RESIDENTIAL
Fee Received by:
PHONE:
L
STATE:
ZIP:
SEmON:
ZONING:
I
ESTIMATED COST OF CONSTRUcnON:
(EXCLUDING LAND VALUE)
SQUARE I J/) IV'\
FOOTAGE: l.....'LLJ
~70 tfj)
(-rIS
0008
TAX MAP PARCEL #:
PLUMBING CONTRACTOR:
tW {~!J.
Plumber's Indiana State ~c e #:
Jn5QO
Which plumbing codes will be applied to the construction:
a International Residential Code w/lndiana Amendments
o Uniform Plumbing Code wI Indiana Amendments
# Charged Re-
ReViews
,DD
Date