HomeMy WebLinkAbout07060028 Application
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City of Carmel/Clay Township Permit #: (:J 70; I..e fJ02<J
COMMERCIAL/INSTITUTIONAL/MUL TI-F AMIL Y IMPROVEMENT LOCATION PERMIT
APPLICATION (For New Structures, Additions, Remodels, Tenant Finishes, & Accessory Buildings)
BUILDER
OF
RECORD:
NAME:
H,,\-\;
STREET ADDRESS:
g-~ (;'
6ft)
ZIP:
'16G'L
CITY.
4..^c1 .
FAX:
g~&q
STATE:
JJJ
~
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BEST METHOD OF CONTACf:
[--lA-...... j
PROPERTY
OWNER:
NAME:
PHONE:
c..2''i~- Il'
S-\" S-k t~o
5.-. Id,~
FAX:
~77 - 7C, r-
LOCATION
& PROJECT
INFO:
ZIP:
CITY:
~d.\,,^_
SUITE #: (If Appllcable)
Address of Shell Building: (If different t
or eon
lot # and Subdivision: (If Applicable)
ZONING:
r2'z;..
TAX MAP PARCEL #:
STATE COMMERCIAL
DESIGN RELEASE #:
o FDN 0 STR ~ ARCH
ELEC 0 SPKLR '6THER(S):
o MECH
o PLUM
3g
WATER UTILITY
PROVIDER:
SEWER UTILITY
PROVIDER:
ESTIMATED COST OF CONSTRUcrrON: it "0
(EXCLUDING LANO VALUE) Jp.s Doa
PLAN COMMISSION / BZA / BPW DOCKET NUMBERS; AND/OR
COUNTY WELL AND/OR SEPTIC PERMIT #'5 (If Applicable):
# of Floors: ~ Elevator or Lift: Q YES BLDG. CONSTRUrnON TYPE: tJ _ ~ OCCUPANCY CLASSIFICATION:
TYPE OF CONSTRUCTION: TYPE OF IMPROVEMENT: PROJECT INFORMATION:
o COMMERCIAL 0 NEW STRUCTURE
(Privately owned hospitals and medical 0 ADDmON
offices/centers are commercial) 0 Room(s)
o INSTITUTIONAL 0 Porch
o Municipal/Public Bldg .~ .Orl~nine or Deck
o School FOR cOt,,1~RRl!MODEC'
i'.r Df@r.<ffiASED , ~,'thtallr~<ti!~~ANISH
y" MULTl-.!'-M1.\'tlCt to CornpllanC~ ~ 'Sd.#.. .r:. ESSORY BUILDING
Numbe'r'br'dnits:Gl <e13'P and Loval 'fi:Jsl~l'!1'Jltt!El!'-'9ARAGE
FOUNDATION ~PlC~~QQv'JiIM~~cj:T~ -r~~~~~~~
apply for the ne~9'f)tr'e"'~ I ~ tJ CELL TOWER CO-LOCATE
'><t SLAB Clll L:i CRAWL Wl'IDItANAo DEM0LIT10N
o POST &_BEAM _PIER 0 BASEMENT (WALKOlJT:_Y_N)
Early Release \ ill
Permit: _Y..L..N
Lot Split: _Y 2LN
Manufactured
Trusses:
Sump Pump:
_y.LN
_YlN
FLOOD ZONE AREA DESIGNATIONCSl FOR THIS PROPERTY:
PLUMBING CONTRACTOR:
lv/A
Plumber's Indiana State License #:
IVfA
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 requeste;d by
this application will comply with, and confom to, all applicable laws of the State of Indiana, and the ~Zoning Ordinance of Cannel Indiana -1993" (Z-289) and amendmerits,
adopted und amhority of l.c. 36-7 et se;q, General Assembly of the State of Indiana, and all Acts amendatory thereto. I further certify that only kitchen, bath, and floor drams are
connected the sanitary sew I further certif that the construction will not be used or occupied until a Certificate of Occupancy or Substantial Completion has been
issued t e D ent m nity S . ces, Carmel, Indiana.
p,~~N-W ~to~~
~ju /07
Da I
OFFICE USE ONLY: *************:t;~:t:*************************************************
~:r ~~"{;rfs k:cfu~;:O~ I c-U ,II Ju ~ Filing Fees: '3 -5/ . (e 0
\.upper .ng~ Lower Footing Under ~o~~ Base Inspections: ",[) 53 , () 0
e ~ !;.H- . "', /I Cert of Occupancy: /! { I 0 0
M t:rBas:ti Site~, TO"l".tL: _ / ~
mmunity Services (Da e) 1 ~~.., .
Fee Received by: Date