HomeMy WebLinkAbout06030067 Application
City of Carmel/Clay Township ~ Permit#: O~03()()fe,.7
COMMERCIAL or INSTITUTIONAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Commercial or Institutional: New Structures, Additions, Remodels, Tenant Finishes, 8< Accessory Buildings
BUILDER of NAME PHONE
RECORD: C o1f}
STREET ADDRESS 01Y
BUILDER'S EMAIL ADDRESS
I- ft iT z...,c:J" t4f1
PROPERTY PHONE
OWNER: I (!) rt. Uc..
STREET ADDRESS 01Y
N C-
fAX
~7S-1.).S3
LOCATION
&. PROJECT
INFO:
ADDRESS OF CONSTRUCTION
l"A.lSG:::> f\J. mE"l (^'
Address of Shell Building (If different than Address of Construction)
BUILDING, PROJECT" OR TENANT NAME: /J
I\"Z- G h '" l..!> fllv; I r'~
STATE
BEST METHOD OF CONTACT: ""
~ /1119-, L
FAX
1~- ).1..S 3
STATE
-r"J
sum # (If Applicable)
Lot # and Subdivision (If Applicable)
STATE COMMERQAL
DESIGN RElEASE #:
SCOPE(S) OF l!!i... FDN \JQ STR 0 ARCH 0 MECH 0
RELEASE: 0 ELEC 0 SPKLR OTHER(S):
G - (p
# of Floors: Elevator or Uft: Q YES !R-NO BLDG. CONSTRUCTION TYPE: C; Iff'> t'
TYPE OF CONSTRUCTION: TYPE OF IMPROVEMENT: PROJECT INFORMATION:
tQ... COMMEROAL 0 NEW STRUCTURE
(Privately owned hospitals 0 ADD(TJON
and medical ~~ces/cente~n rnf\,~~,TRUCT\UJN Room{s)
~~me~,ryED Fe..... - ". 1",P,sPorch
o IN~g.~~~ {'r~1.)i:': a;;C\:. 'N\th _'~"! :'C:"dU o...b" Mezzanine or Deck
QUMuntapal/~~~i'c~ ~1,d9. 1 ',C2, C;c.oJlt.. REMOREL
~ ~ChhOOhlOOj F" 'c:::' ;",';, "1';"( :; ,PI \iNEW~il:NANT FINISH
'-'1)1", u(C - ,',--,",..",. . "~ ACCE~Y BUILDING
FOUNDATI9~"T~~\>{9'~~i~!I. ~!!ich:' i I\{ I EJ {'DEtACHED GARAGE
apply for lIie,new COl'Istrllction area)A' 'I u 0 ATTACHED GARAGE
INU' ""
jig SLAB 0 CRAWL SPACE 0 CEll TOWER (New)
o POST & BEAM 0 BASEMENT 0 CELL TOWER CO.LOCA TE
(or POST & PIER)' WALKOUT:_Y_N 0 DEMOLITION
WATER UTILIlY
PROVIDER: Lv E. \ \
SEWER UTIliTY
PROVIDER: ClR u.J ()
PLAN COMMISSION / BZA / BPW DOCKET NUMBERS; AND/OR
COUNTY WELL AND/OR SEPTIC PERMIT #'S (If Applicable): 6 S \"")" 00" I
TAX MAP PARCEL #:
ESTIMATED COST OF CONSTRUCTION:
(EXCLUDING LAND VALUE)
00 000,
Early Releas<;", ,/ Manufactured y
Permit: ~y -E-N Trusses: ~Y_N
Lot Split: _Y XLN Sump Pump: _y...2(N
Does any part of the property lie within a special Flood
designation area: _Y LN
mBING CONTRACTOR:
f--" A
Plumber's Indiana State License #:
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 Cannel Indiana -1993n (Z'
289 d amen ts, adopted under authority of LC. 36~7 et seq, General Assembly of the State of Indiana, and all Acts amendatory thereto. I further certify that only
ch door drains are connected to the sanitary sewer. I further certify that the construction will not be used or occupied until a Certificate of
Dee ubstantial Completion has been issued by the Department of Conununity Services, Cannel, Indiana.
ChPrn fES Lt}"7-7 M/f
Print
~-q-O <0
ate
OFFICE USE ONLY: ************************************************************************
CTIONS REQUIRED: ,~t<l. (.I: Filing Fees: /3 (}{p I 6)0
. t~\ "> \ ' C1 -? c- () # Charged Re.
Lower FootIng Under Slab )"1 ~ .ft'~\~'6 Base Inspections: ! / I' 'J ReVlews
MeterBase 8 ~(\j; ~;:;?' Cert. of Occupancy: J1tJ3, DO
~ G~ 1 ~~ TOTAL : OJ, .50 Additional Fees
0(0
Upper Footin
Rough In
So
Revlewed/A proved: Dept. of Community Services (Date)
S:PermIts/Fonn ILP COMMEROAL
Fee Recel