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City of Carmell Clay Township Permit #: 0'7010 15(p
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Town Home, & Two Family: New Structures, Additions, Remodels, & Accessory Structures
,
BUILDER
OF
RECORD:
NAME:
c:S \AI. M
-
c.:
PHONE:
( , -g~4-3gtll
FAX:
STREET ADDRESS:
STATE:
V
ZIP:
BUILDER'S EMAIL ADDRESS:
LOCATION
& PROJECT
INFO:
/,
PROPERTY
OWNER:
NAME:
(?
CITY:
/A/.o,l,4,u 'POL/J
STATE:
ZIP:
#'?
o
SECTION: ZONING:
t:::
SUrlj5ct tD compliance wit
LOT #:
ADDRESS OF CONSTRUCTION:
SEWER LITIUTY
PROVIDER:
WATER UTILITY
PROVIDER: (! 11"'(
NAME OF UTILITY EXCAVATION CONTRACTOR; PlAN COMMISSION / BZA! BPW DOCKET '..A
NUMBERS; TAC OATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'S (IF APPLICABLE): j/f'f
FLOOD ZONE AREA DESIGNATION(S)
FOR THIS PROPERTY: 't7T
TYPE OF CONSTRUcnON:
* SINGLE FAMILY
-15' TOWN HOME
o TWOFAMILY
#(of units being
" constructed at this
, ''--....:.time:
'lI, '~ESIDENTIAL (For
r Additions. Remodels. Etc.)
,i I
, I
"
2 3 2007
<: i;:
., ;"
I 'I
liL/
o
o
~
o
NEW STRUCTURE
ROOM ADDITION(S)
PORCH ADDmON(S)
DECK ADDmON(S)
REMODEL
_ Basement Finish only
o ACCESSORY BUILDING
o DETACHED GARAGE
o ATTACHED GARAGE
o DEMOLITION
Which plumbing codes will be applied to the construction:
o International Residential Code wI Indiana Amendments
o Uniform Plumbing Code wI Indiana Amendments
PROJECT INFORMATION:
Early Release ~M~nufactured
Permit: _Y N Trusses:
Lot Split: _Y _ Sump Pump:
FOUNDATION TYPE: (Check all that apply for the new
construction area)
_yLN
_YlLN
o
}5J
CRAWLSPACE
o POST &
BEAM _PIER
SlAB 0 BASEMENT (WALKOUT:_Y_N )
OFFICE USE ONLY: *************
Base Inspections:
Cert. of Occupancy:
# Charged Re-
Reviews
P.R.I.F,:
I Additional Fees
TOTAL: ;!! 3{.(., .5".0
t1 tfAt~ 11' hi /1 wui
v '-1/2 "7--}6 "late
I/~ ~t/...u7
(Date)
S:PermitsjFormsjllP RESIDENTIAL
Fee Received by: