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S:\Permits\TEMPORARY ILPs\Fireworks_Special Events Application,doc
CITY OF CARMEL, INDIANA - DEPARTMENT OF COMMUNITY SERVICES
\
TEMPORARY USE APPLICATION
FIREWORKS SALES OR SPECIAL EVENT
OIVISON OF BUILDING AND CODE ENFORCEMENT
INCOMPLETE APPLICATIONS WILL DELAY PERMIT REVIEW.
COMPANY NAME: 0 . is
APPLICANT NAME: Ia
ADDRESS OF APPLICANT /)'1J 3 7hIM/;t7J()Ke. pt(.n
~DDRESS ~ '"7
PROPERTY OWNER NAME: .1)ay;d hI/I;
ADDRESS OF OWNER: /)J/J] ~~"~JM/;r60/J( frJl..UJ
..frffl-RESS ~-r
TEMPORARY USE INFORMATION 0
(PLEASE PRINT OR TYPE)
PHONE# (3-/7) xt -f~3
FAX# (3/1) 5;;tn'f"1tJ/
fuJheI y;,; %tl33
CITY STATE ZIP CODE
PHONEtI (3/ n 1/,j,?-.5;20 t/
Cum z;J ~tl33
CITY STATE ZIP CODE
APPLICANT/OWNER INFORMATION
NAME OF BUSINESS/ORGANIZATrON '/1 t
ADDRESSOFTEMPORARYUSE (4 /M/ltU .2Jt/
DATE(S) OF PROPOSED USE: ,IlL); .J-~, ~1500 HOURS OF OPERATION: lo-f
DESCRIPTIONOFTEMPORARYUSE M~ lid-Co hd I&Cu;ye/ ~/i5'OC:-(4j~
WILL THE TEMPORARY USE BE OUTDOORS? ~ or NO
WILL THE TEMPORARY USE REQUIRE A STR URE? (tent,~, or mobile unit)cYESJ or NO
IF SO, WHAT TYPE OF STRUCTURE AND INDICATE SIZE lP/l1-- ~)(~
("NOTE MOBILE UNIT REQUIREMENTS ON BACK") MOBILE UNIT CERTIFICATION #:
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)
SPECIAL EVENT ,
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 INSTALLEm YES or NO
HAS THIS STRUCTURE PREVIOUSLY BEEN USED FOR THE SALE OF FIREWORKS? YES or NO
CERTIFlCA TION AND NOTICE OF INTENT TO COMPLY i
I hereby certify that I have the authority to make the foregoing application, that the'application and plans filed with the application ale
c'?")nd that t~: ope::? ~nd conduct ~f the temporary use will conform to rI:::QtiO~S : t~_~rm~ Zoning ordin~c,e.
S~(Rl:~mf~ 5Ignature~rop:~~erthQ~
OFFICE USE ONLY (DO NOT WRITE IN)
PERMIT#: OQ:.o700'71
APPLICATION REVIEWED BY: K(5
REQUIRED INSPECTIONS:
o ELECTRICAL (B",CE) 0 SITE (PLANNING) )( FIRE DEPAR . " ENT
Call (317) 571- 2444 to schedule Electrical '" Site Inspections I! a Q)
Call (317) 571-2600 to schedule Fire Department Inspection fir :;v
ZONING:
DATE: 07/ Jl/ ~
PARCEL #
PERMIT FEES:
~~-(3)JL~;"r[-~ t'Fee)
0$267.00 (Use Permit Fee)
0$100.00 (Site Inspection Fee)
0$80.00 (Sign Permit Fee)
TOTAL FEES DUE: $ NO
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ONE CIVIC SQUARE
DEPARTMENT OF COMMUNITY SERVICES
CITY OF CARMEL. INDIANA
(317) 571-2444
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