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S:\Pennits\TEMPORARY ILPs\Fireworks_Special Events Application.aoe
CITY OF CARMEL, INDIANA - DEPARTMENT OF COMMUNITY SERVICES I
TEMPORARY USE APPLICATION
FIREWORKS SALES OR SPECIAL EVENT
DIVIS ON OF BUILDING AND CODE ENFORCEMENT
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INCOMPLETE APPLICATIONS WILL DELAY PERMIT REVIEW.
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APPLICANT I OWNER INFORMATION (PLEASE PRINT OR TYPE) I
COMPANY NAME P ~C Ac ~c... FA-e.i'\S c~e,\j IVAt..5 PHONEti' (812. ) 92 l( - ;'50~
APPLICANT NAME 1\ <A:.'f'^L ,(J""""C,,,>5 r FAX#: (6\2.-) b<:l( - 05(,& [
ADDRESSOFAPPLICANT 'Aq, w C'-'\A.VL"'- loJ &/OOl'1:"?b.- ::w 4,l{o'<, I
ADDRESS ClIT STATE ZIP CODE
PROPERTY OWNER NAME /.. ).,,,.I4">~hv Cl"...~.b",~ C("vc'^'- PHONEII': {'517
ADDRESS OF OWNER: 5,,3 S E i3i,,;I- ..,t~c.~ C",.""-e\ -liv
ADDRESS CITY STATE
),)77 -..2(,5~
L((,O~ '3
ZIP CODE
TEMPORARY USE INFORMATION 0 FIREWORKS SALES /l1SO SPECIAL EVENT I
NAME OF BUSINESS/ORGANIZATION: if h.r ~v '- e--> ["'if ~ ~ \.i'l:<..... cJ'l'-W (~
ADDRESS OFTEMPORARY uSE'i5Jt;;" &- I :;;/6/- 'Sbe-el-
DATE(S) OF PROPOSED USE: q~I(-;lOO'" HOURS OF OPERATION: II",.." 1-0 lep,",
DESCRIPTION OF TEMPORARY USE: ~ ~ =/t 050"10 II c.:,
~ -...p 0 r s-ra:*:6 riolL ; ^--Io
WILL THE TEMPORARY USE BE OUTDOORS? ~ or NO "'
WILL THE TEMPORARY USE REQUIRE A STRUCTURE? (tent, stand, or mobile unit) YES orcNO.-:=o
IF SO, WHAT TYPEOF STRUCTURE AND INDICATE SIZE: .
('NOTE MOBILE UNIT REQUIREMENTS ON BACK*) MOBILE UNlT ~IFICA TION #:
WILL THE TEMPORARY USE UTILIZE A TEMPORARY SIGN? YES o~
(' NOTE TEMPORARY SIGN REQUIREMENTS ON BACK')
IF APPLICATION IS FOR FIREWORK SALES:
(PLEASE REFER TO ADDlTIONAL APPLICATION REQUIREMENTS FOR FIREWORKS SALES ON BACK)
WILL THE STRUCTURE BE USED FOR THE SALE OF MORE THAN 500 ILBS OF FIREWORKS? YES or NO
DOES THE STRUCTURE ALREADY HAVE A SPRINKLER SYSTEM INSTALLED? YES or NO
HAS THIS STRUCTURE PREVIOUSLY BEEN USED FOR THE SALE OF FIREWORKS? YES or NO
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CER TIFICA nON AND NOTICE OF INTENT TO COMPLY "
I hereby certify that I have the authority to make the foregd"g application, that the ~plication and plans filed with the application are
e,;d that the~ion and conduct of the te . brary u~ Y?' to the egulations of the Carmel/Clay Zoning Ordinance.
ignatu pp . cant
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OFFICE USE ONLY (DO NOT WRITE IN)
PERMIT#: (J")'oq OO~ _
APPLICATION REVIEWED BY: 1<13
REQUIRED INSPECTIONS:
o ELECTRICAL (B&CE) ~SITfUPLANNING)
ZONING: PARCEL#:
DATE Q!L/ su./ 0 :,...... PERMIT FEES:
I )sitl;128.75 (Special Event Fee)
~LREDEPAiHMEN-r I 0$257.50 (Use Permit Fee)
- , . "~ !:iI$96.25 (Site Inspection Fee)
Call (317) 571.2444 to schedule Electrical &: Site Inspections 0$77.25 (Sign.r'.etmit!~e~ ." '~-O'/.1 '
Call (317) 571.2600 to schedule Fire Department Inspection t<?T 4~~.~S;DUg$;A,.C-i%';;(J;';" .J~...
ONE CIVIC SQUARE
DEPARTMENT OF COMMUNITY SERVICES
CITY OF CARMEL, INDIANA
(317) 571.2444
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