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CityafCarmel/Clay Township Permit #: 0705G019
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Town Home, &. Two Family: New Structures, Additions, Remodels, &. Accessory Structures
Y'
BUILDER
OF
RECORD:
PROPERTY
OWNER:
LOCATION
&. PROJECT
INFO:
NAME:
lLC-
PHONE:
OTY:
::c-'" I ,
STATE:
ZIP:
46<)
STREET ADDRESS:
lsL~ E. '7
-::t:-AJ -
~'-I0:0,
BUILDER'S EMAIl ADDRESS:
e\,,-,,,\o.: ':;0o..~6\"L>~ \
BEST METHOD OF CONTACT:
e......C<.,; I
NAM.EK
\t-lr'\ocv-
UL
FAX:
STREET ADDRESS:
!..<..,Gc, l;.-,7.--:e"
CITY:
<c;
STATE: ZIP:
.~, 4l.oQ :
SECTION: ZONING:
':::,-
LOT#:
SEWER UTILITY f'o-.:.
PROVIDER: ~ \ '\C\.&:>
SUBDIVISION NAME:
\W. \-r-c..,\
'.'^-
WATER UTILITY ('> \
PROVIDER: \.....c.........,.... ~
ESTIMATED COST OF CONSTRUCTION'
(EXCLUDING.LANO.VAlUE)------'''\''''c:
I ~ ff=' ~ ~, n~;:;y0.
~WJ~: ,,~
~ Ih
TAXIP tiRCE'MAY 1 0 2007
NAME OF lJTlLITY EXCAVATION CONTRACTOR; PLAN COMMISSION / BZA / BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'S (IF APPLICABLE):
FLOOO ZONE AREA DESIGNATION(S)
FOR THIS PROPERTY:
TYPE OF CONSTRUCTION:
Ii<l" SiNGLE FAMILY
o TOWN HOME
o TWO FAMILY
# of units being
constructed at this
time:
o RESIDENTIAL (For
Additions. Remodels. Etc,)
PROJECT INFORMATION:
Early Release
Permit:
Lot Split:
_yLN
_V..:LN
RELEASED
TYPE OF I~MfNlIr1pliance
.~ NEW ${lUIQ:u'il.bState and Loca .....k.\
o RooH.\9b'rti6'rI{5j:OMMU~ a ill!State License #:
~ ~~~~~~MEL / CL\'\@.~P
o REMODEL . . h IN I DJAN-AiCh plumbing codes will be applied to the construction:
_ Basement FinIS on y
o ACCESSORY BUILDING ~Intemational Residential Code wflndiana Amendments
o DETACHED GARAGE
o ATTACHED GARAGE
o DEMOLmON
;.
o Unifonn Plumbing Code wflndiana Amendments
Manufactured
Trusses:
Sump Pump:
I
FOUNDATION TYPE: (Check all that apply for the pew
construction area)
Ji....Y_N
LV_N
o CRAWLSPACE 0 POST & BEAM PIER
o SLAB ~ BASEMENT (WALKOUT:_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 Cannel Indiana - 1993n (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 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
Occupan has bee ue e Department of ommuOlty Semces, Cannel, Indlana
OJ ~~r ~\:s' 7, \\~ "'Ys~
Pnnt .... ~
OFFICEUSEONLY:*********************************************************************************
INSPECTIONS REQUIRED: Filing Fees: ~~,3 ---:'1 LJ
Base Inspections: ;;;}j 7 ) # Charged Re-
Upper Footing Under Slab ReViews
Cert. of Occupancy: S'5 SO
6/60
cJ
'5 -Ia{))
Date
Site
Date
P.R,I.F.:
Addibonal Fees
Reviewed/Approved: Dept. of Community Services (Date)
S:PermitsjFOfmsjILP RESIDENTIAL
Fee Received