HomeMy WebLinkAbout07040110 Application
City of Carmel/Clay Township Permit #: 07{)~f)(j()
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLIC.A!TION
For Single Family, Multi-Family, & Two Family: New Structures, Additions, Remodels, & Accessory St~uctures
LOCATION
& PROJECT
INFO:
PHONE <i5L/
CITY
BUILDER of
RECORD:
Y'Y\
PROPERTY
OWNER:
NAME
PHONE
STREET ADDRESS
STATE
ZIP
SUBDIVISION NA
SEmON
ZQNlNG:
SQUARE
FOOTAGE:
SEWER llTlLITY
PROVIDER:
WATER UTILITY
PROVIDER:
NAME OF llTlLITY EXCAVATION C NTRACTOR; PLAN COMMISSION / BZA / BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'5 (IF APPLICABLE):
~!SPF CONSTRUcnON:
~ SINGLE FAMILY
o TOWN HOME
o TWO FAMILY
# of units:
o MULTI-FAMILY
# of Units:
o RESIDENTIAL (For
Additions, Remodels, Etc.)
PROJECT INFORMATION:
Early Release / Manufactured
Permit: Y V N Trusses: N
. / o~~~cr
Lot SplIt: Y 1N Sump Pump: N 0 SLAB
Does any part of the property lie within a special Flood designation area: _Y_N
For Single Family and Two Family dwellings, additions, remodels, and/or accessory structures, this permit is valid only if construction commences
within 180 days of the date of issuance of the building permit, and must be completed (Certificate of Occupancy issued) within 18 months of the
issuance date. Class I structure permits 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 Carmel
Indiana -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 cersify that only kitchen, bath, and floor drains are connected to the sanitary sewer. I further certify that the construction will not be
used or cupied until a C Iicate 0 cupancyhas been issued by the Department 0 Community Services, Carmel, Indiana.
Print
Lf-q -61
Date
OFFICE USE ONLY: **********************************************~*~**********************
Filing Fees: ~ S f stl
INSPECTIONS REQUIRED: .. ') P 2 r'/)
~ ---,<-"~ Base Inspections: ~(/ ~' 2.Y
'UPJH!r Footiflg ~Wer FO~9 Under Slab - ~ -t)
, G ,Cert. of Occupancy: ,)-J
~cRlgll~~~~r ~e Final Si~ &,1 tf(}
_ P.R.I.F.:
0JL ~d3/(3-S()
Reviewed/Approved: Dept. of Community Services (Date)
S:PermIts/FormS/ILP RESIDEJ'ffiAL
# Charged Re-
ReVIews
Additional Fees
t-tk1\o1