HomeMy WebLinkAbout07050165 Application
City of Carmel/ Clay Township Permit #: Cl77JSDf res-
COMMERCIAL/INSTITUTIONAL/MULTI-F AMIL Y IMPROVEMENT LOCATION PERMIT
APPLICATION (For New Structures, Additions, Remodels, Tenant Finishes, & Accessory Buildings)
BUILDER
OF
RECORD:
NAM""":b
PHONEp'
L.
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FAX:
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9+
STREET ADDRESS:
f.r,(JQ
S-Iv-e <0- *fTY:
BUILDER'S EMAIL ADDRESS: I I
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NAME: PHONE: 3 i 1-
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BEST METHOD OF CONTACT:
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PROPERTY
OWNER:
FAX:
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t.e>
STREET ADDRESS:
00 2.
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SUITE #: (If Applicable)
LOCATION
& PROJECT
INFO:
ADDRESS OF CONSTRUCTION: -n....
00 ~. 9 f.s, -
Siv- -e ~+
o
Address of Shell Building: (If different than Addr€:ss of Construction)
Lot # and Subdivision: (If Applicable)
BUILDING, PROJECT, OR TENANT NAME:
r3
- (}O...
'- ~ I
00/
SCOPE(S) OF . 0 FDN 0 STR rM" ARCH 0
RELEASE: )€ ELEC 0 SPKLR OTHER(S):
'+ L{ J-J....
SEWER UTILITY
PROVIDER: ~ l G.-
PLAN COMMISSION / BZA I BPW DOCKET NUMBERS; AND/OR
COUNTY WELL AND/OR SEPTIC PERMIT #'5 (If Applicable):
ESTIMATED COST OF CONSTRUCTION:
(EXCLUDING LAND VALUE) 1.3 0 0 000
# of Floors: Elevator or Lift:' g,.~~~ q~~. CQNSTRUmON TYPE: OCCUPANCY CLASSIFICATION:
TYPE OF CONSTRUCTION: 'CC'l-\ "1)(~1i'9"\iMPROVEMENT: PROJECT INFORMATION:
~ COMMERCIAL '" ~Oo;::\ ..e ~,\''''' ~h0e"NEY\\.m>~ IRE Early Release p(
(privateIY..!I-"iQe<MOSPita1ii,'i\<){fme%<efo\ -'0--01'itl~\? Permit: _Y_N
ofr~'I'~'\1r~~erCi~ll) '- , .:\l ':::> J&Dl~1?o'm(s) ()c
o IN5TMl'r[q~t\O'cc.~e\ee \-!\0\'\\ ~-\'-LJ Porch Lot Split: _Y_N
o S'fOOcIPal,O'Ub1I~ \ C0 M' 0 Mezzanine or Deck
o School ~.o~ ~'C.\.- ~ REMODEL FLOOD ZONE AREA DESIGNATIONISl FOR THIS PROPERTY:
o Ql<IKIi' cO Cp..S' \~0\f" 0 NEW TENANT FINISH V!.~ i J ,~ '"' h' ;::J J. Or.;-I
o MULTHAiofi.i4't 0, \ 0 ACCESSORY BUILDING Do ~ J -f-'-C -' g
Number~\'),i/s: ~ 0 DETACHED GARAGE ' .
. 0 AlTACHED GARAGE PLUMBING CONTRACTOR:
FOUNDATION TYPE: (Chec~ all which 0 CELL TOWER (New) (l A-L.. m I I
apply for the new construction area) 0 CELL TOWER CO-LOCATE - 0 (Y"o. V\U (J -e clA..6'......o' r - b-
Et SLAB 0 CRAWL SPACE 0 DEMOLITION Plumber's Indiana State License #:
o POST&_BEAM _PIER 0 BASEMENT (WALKOUT:_Y_N) -.::pC to;) OOO:5,St
12e.pv\...
Manufactured
Trusses:
Sump Pump:
_Y 'A N
_Y A:-N
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 - 1993~ (Z~289) and amendments,
adopted under authority of l.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 tbat the construction will not be used or occupied until a Certificate of Occupancy or Substantial Completion has been
; th, D'panm,nt of Co mun;ty S",,;m, Catmd, Ind;ana. I /
I (,y,f V Co. ttr=--r-i. 'v'/ G- t;; -/ 7- -V =r-
Print T" Date
OFFICEUSEONLY:*********************************************************** ************
INSPECTIONS REQUIRED: Filing Fees: J'11J
;;19<<, t0f)
~O
Upper
Base Inspections:
Site
Cert. of Occupancy:
Date
ReviewedjAppr ved: Dept. of Community Services
S:Permits/FormS/llP OMMEROAl
7
TOTAL :
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Fee Received by:
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