HomeMy WebLinkAbout04120086 Application
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City of Carmell Clay Township Permit #: 01/:J.. VO
COMMERCIAL or INSTITUTIONAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Commercial or Institutional: New Structures, Additions, Remodels, Tenant Finishes, l!o. Accessory Buildings
~ .317'
BUILDER of NAME PHONE
RECORD: - c ./.
STREET ADDRESS CITY
.0. e,DX ::TNo'
BUILDER'S EMAIL ADDRESS
PROPERTY NAME
OWNER:
5IREET ADDRESS
LOCATION
& PROJECT
INFO:
ADDRESS OF CONSTRUCTION
BUILDING, PROJECT, OR TENANT NAME:
1'1?' 5, 'Q
STATE COMMERCIAL
DESIGN RELEASE #:
WATER UTlLTIY
PROVIDER:
SEWER UTlLTIY ' /J
PROVIDER: ~,&u.;:Y
PlAN COMMISSION / BZA / BPW DOCKET NUMBERS; AND/OR
COUN1Y WELL AND/OR SEPTIC PERMIT #'S (If Applicable):
# of Floors:
Elevator or Un:: 0 YES ~o
BLDG. CONSTRUCTION TYPE:
TYPE qF CONSTRUCTION:
cWCOMMEROAL
(Privately owned hospitals
and medical Offices/centers
are commerdal)
o INSTITUTIONAL
o Municipal/Public Bldg
o School
o Church
FOUNDATION TYPE: (Check all which
apply for the new construction area)
~LAB 0 CRAWL SPACE
o POST & BEAM 0 BASEMENT
(or POST & PIER) WALKOlJT:_Y_N
TYPE OF IMPROVEMENT:
o NEW STRUCTURE
o ADDmON
o Room(s)
o Porch
o Mezzanine or Deck
g., REMODEL
~ NEW TENANT FINISH
o ACCESSORY BUILDING
o DETACHED GARAGE
o ATTACHED GARAGE
o CELL TOWER (New)
o CELL TOWER CO-LOCATE
o DEMOLmON
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FAX
3n,J",JS. 1'17
STATE
ZIP
.;Ii, 2. I
<'i''' "
ZIP
Lot # and Subdivision (If Applicable)
G
.
ZONING:
e f4i-j
""'ARCH ""'MECH ~LUM
OTHER(S):
ESTIMATED,COST OF CONSTRUCTION:
(EXCLUDING LAND VALUE)
00
OCCUPANCY CLASSIFICATION:
PRO ECT INFORMATION:
Early Release /. Manufactured /
Permit: y-Y _N Trusses: 'L-Y_N
Lot S~lit: _Y LN Sump Pump: _Y ~N
Does any part of the property lie within a special Flood
designation area: _Y LN
PLUMBING CONTRACTOR:
~U5'I()n'I l/vmJMJ
Plumber's Indiana State License #:
I'c. /9'1 {llJ7.:2
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
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 Cannel Indiana -1993" (Z'
289) and amendments, adopted under authority ofI.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
Occupanc or Substantial Completion has been issu -tiy the artment of Community Services, Carmel, Indiana.
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Print
Signature of Owner or Authorized Agent
~
OFFICE USE ONLY: **********
INSPECTIONS REQUIRED:
Upper Footing Lower Footing Under Slab
e=s Meter Base G Site
Filing Fees:
Base Inspections:
Cert. of Occupancy:
# Charged Re-
Reviews
hditiOnal Fees
:D/l,(._ \ . '2Cl:+
oved: Dept. of Ccmmunity Services (Date)
COMMERCIAL
fen? p,o r-I. I
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/a.9-pij
Date
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