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City of Carmel/Clay Township Permit #: o70(//0()3S
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Town Home, 8< Two Family: New Structures, Additions, Remodels, 8< Accessory Structures
BUILDER NAME: Bvlvber&S, 1.-.,.<:,. PHONE: FAX;
Of ~(k)c:t tj'tI,.J~~ 31'7-5""'lS-QCt'jS- 311 - sq~ - 2-1" I
RECORD: STREET ADDRESS: CI1Y: STATE: ZIP;
,?,j8.g C/ZPr l~ <f:1. /i:(oo J"t}'4:~Afo~IS r,.1 46, ZSl>
BUILDER'S EMAIL ADDRESS: r?v.f BEST METHOD OF CONTACT:
t; 1\1 <6 ku ~ Ch" ".{..rot. f>" .. {d.....; .6>...... Mosha... cdl Jf1-1/'-i-'5:7'lz..
PROPERTY NAME: PHONE: FAX:
OWNER: fVI bN{)/J .. /1114(,.1 I u-c.. 1&.M{. ~ ".kk>V"L.
STREET ADDRESS: <lb.,v(.... CI1Y: STATE: ZIP:
<;I{~ W7
LOCATION LOT #: SUBDIVISION NAME: ~ ((. S~\ON: ZONING: pu b
8< PROJECT II\C fvlDlJo,J ~ MAl,.] f2e"'lBP,..,.,,,
INfO: ADDRESS OF CONSTRUCTION: ./ SQUARE Z(/~..r/1
60 ~(,.o(4?r>a;: <g;-. 6A:(l..\1Gt...--, r,J tb2 f Z- FOOTAGE:
SEWER LJTIlITY () 1-\ (l "tt;? \....- I WATER UTIlI1Y CM.W\eL.- I ESTIMATED COST OF CONSTRUCTION: ./i(u, o17<f)
PROVIDER: PROVIDER: (EXCLUDING LAND VALUE)
NAME OF umlI1Y EXCAVATION CONTRACTOR; PLAN COMMISSION / BZA / BPW DOCKET 10'1 a.v; f)(l t'I"M( ""<( (lvp ~ ~.d:
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'5 {l> AOP'-'CABLIli ([ PP fA vl>(.tt- 0401 DO 3/~ b<t-01 "Q SS-Z-
FLOOD ZONE AREA DESIGNATION(S) ~)G .. ~ I TAX MAP PARCEL #: "-d'\-'Z'>-.'2.-c:3-o"20.""'"'
FOR THIS PROPER1Y: "1A>,.::>e i/..-otl-2S'-02.-t>~-""I. """
TYPE OF CONSTRUCTION:
o SINGLE FAMILY
~ TOWN HOME
o TWO FAMILY
# of units being
constructed at this
time:
o RESIDENTIAL (For
Additions. Remodels. Etc.)
PROJECT INFORMATION:
Early Release
Permit:
Lot Split:
_Y~N
_y-.kN
TYPE OF IMPROVEMENT:
~ NEW STRUCTURE
o ROOM ADDITION(S)
o PORCH ADDITION(S)
o DECK ADOITION(S)
o REMODEL
_ Basement Finish only
o ACCESSORY BUILDING
o DETACHEO GARAGE
o ATTACHED GARAGE
o DEMOLITIDN
Manufactured
Trusses: ~y _N
Sump Pump: _Y -kN
PLUMBING CONTRACTOR:
(l,! R- f1;J1M8i~4
plumber's Indiana State license #:
ePmDvl~S'
Which plumbing codes will be applied to the construction:
~ International Residential Code wI Indiana Amendments
o Uniform Plumbing Code wI Indiana Amendments
FOUNDATION TYPE: (Check all that apply for the new
construction area)
o CRAWLSPACE
o POST &
BEAM _PIER
For Single Family and Two Family dwellings, additions, remodels, and/or accesso~~S r is vl!l~Q.,ft.hal\ IOn commences within 180
days of the date of issuance of the building permit, and must be completed (Certifil!rtl,"o'fQ~IOO~Jl. ~9\\rith'tW ~~ths .of the issuance d:l~e. ~Iass I
structure pennits are subject to the General Administr~tive Rules of the St.ate of I~~\. of:b-I(tfte~~1A1Wg"~lIA~\!\'V1{JiS::s for begmmng and
completmgconstrUctlOn. 0 1"'\f\^t\AUN\l "f ~ ~UIP
I, the undersigned, agree that any construction, reconstruction, enlargement, relocation, p-\ ~~~. ~ aG.~Jtl, o~ ~ C~E!voWN~:Ma, or stt1.lctures
requested by this application will comply with, and conform to, all applicable laws of the ~dttlof'I '~lf-~etPPihg~d.ihance of Cannel IndIana -1993~ (2-
289) and amendments, adopted under authority of r.c. 36-7 et seq, G.eneral Assembly of~f~eQ" ncft49, an 1 ~A'\11\mdatory thereto. I further certify that only
kitchen, bath, or drams are connected to the sanitary sewer. I further certify tha'r'the construction will ~6~ u~ea'or occupied until a Certificate of
Occupancyh be is ed by the Department f Community Services, Carmel, Indiana.
'7lon M. Mo<;;M
OFFICEUSEONLY:*********************************************************************************
PECTIONS REQUIRED: Filing Fees:., f1 t c; , ~O
B I ct c 7 <<-0 # Charged Re-
U F t. L F t' U d SI ase nspe Ions, D, \J
pper 00 I ower 00 mg n er a C ReViews
Cert, of Occupancy: v6. 6 0
P.FU.r.: ~ /rClrl;L'1. P<2-/q Additional Fees
'~;r/..=~1f We foff:zI07
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