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\\Apps2\docs shared\Pennits\TEMPORARY ILPs\Fireworks~Special Events Application 2007.doc
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CITY OF CARMEl, INDIANA - DEPARTMENT OF COMMUNITY SERVICES
TEMPORARY USE APPLICATION
FIREWORKS SALES OR SPECIAL EVENT
DiVISON OF BUILDING AND CODE SERVICES
INCOMPLETE APPLICATIONS WILL DELAY PERMIT REVIEW.
APPLICANT I OWNER INFORMATION
COMPANY NAME CAa-t<^\GL tJ f'rfA
APPLICANT NAME _ l~') B 4t L.e'f
ADDRESS OF APPLICANT: i l ( I\-L b--ot. LA-L D-e.
ADDRESS
(PLEASE PRINT OR TYPE)
PHONE#: (311
FAX#&il )
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CITY
) cY'-N - 3'77-.5
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STATE ZIP CODE
PROPERTY OWNER NAME
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PHONE#: (611) 2-2.3 - g01<-
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CI ZIP CODE
ADDRESS OF OWNER:
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ADDRESS
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TEMPORARY USE INFORMATION 0 FIREWORKS SALES
NAME OF BUSINESS/ORGANIZATION: N' f>rPb
ADDRESS OF TEMPORARY USE: It l V\.~, LA L vlZ-
DATE(S)OFPROPOSEDUSE fo - 23 - ro{ HOURS OF OPERATION: (f,,/>-.. - 4 f'^"'
DESCRIPTION OF TEMPORARY USE
WILL THE TEMPORARY USE BE OUTDOORS' Q,r NO CJ.
WILL THE TEMPORARY USE REQUIRE A STR~RE) (tent, stand, or mobile unit) ~ or NO
IF SO, WHAT TYPE OF STRUCTURE AND INDICATE SIZE ievr-
("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 ADDITIONAL 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
CERTIFICATION AND NOTICE OF INTENT TO COMPLY
OFFICE USE ONLY (DO NOT WRITE IN)
PERMIT #:\
APPLICATION REVIEWED BY:
REQUIRED INSPECTIONS:
o ELECTRlCAL (B&:CE) 0 SITE (PLANNING)
ZONING:
DATEOo / ~ Q.3::
o FIRE DEPARTMENT
PARCEl#:
Call (317) 571'2444 to schedule Electrical &: Site Inspections
Call (317) 571,2600 to schedule Fire Department Inspection
PERMIT FEES:
I j21.$I3850 (Special Event Fee)
0$277.50 (Use Permit Fee)
0$104.00 (Site Inspection Fee)
0$83.00 (Sign Permit Fee)
TOTAL FEES DUE: $ i3f). SO
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ONE CIVIC SQUARE
DEPARTMENT OF COMMUNITY SERVICES
CITY OF CARMEL, INDIANA
(ll?) 571,2444