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C't ifC IIC" 7' h' Permit #: fJ '10<0 O()2~
I Y 0 arme ,ay .I. owns Ip I
COMMERCIAL/INSTITUTIONAL/MUL TI-F AMIL Y IMPROVEMENT LOCATION PERMIT
APPLICATION (For New Structures, Additions, Remodels, Tenant Finishes, & Accessory Buildings>:
,
BUILDER
OF
RECORD:
NAME:
Co\;- C Q..
ovru.",-
PHONE:
FAX:
STREET ADDRESS:
CITY:
STATE:
ZIP:
BUILDER'S EMAIl ADDRESS:
BEST METHOD OF CONTACT:
PROPERTY
OWNER:
NAME:
C--c
PHONE:
- ~lb' 2.~I"
FAX:
311- t1 b-2SI'>
STREET ADDRESS:
~
ADDRESS OF CONSTRUcrrON:
&40 N-. rv\,'L\":,
STATE:
ZIP:
L\ 1:::l<:>3,-
y~
Address of Shell Building:
SUITE #: (If Applicable)
\3,-10"2..-
LOCATION
&. PROJECT
INFO:
lot # and Subdivision: (If Applicable)
BUILDING, PROJECT, OR T~ANT NAME:
s~~e.A ( ~vo<<--
STATE COMMERCIAL
DESIGN RELEASE #:
ZONING: TAX MAP PARCEL #:
'DQ...\. 11' 30,OODOO UDJ.
SCOPE(S) OF 0 FDN 0 STR 0 ARCH 0 MJ;C~ 0 PLUM SQUARE 0
RELEASE: 0 ELEC 0 SPKLR OTHER(S): e;.,(HHV~T ...!bDO FOOTAGE: \':>
WATER UTILTIY
PROVIDER: Co.Y~
u
SEWER UTILITY
PROVIDER: C"T f2-W D
N/A
ESTIMATED COST OF CONSTRUCTl~
(EXCLUDING LAND VALUE) .." I ,C/O";). 6~
PLAN COMMISSION I BZA I BPW DOCKET NUMBERS; AND/OR
COUNTY WELL AND/OR SEPTIC PERMIT #'S (If Applicable):
# of Floors: l Elevator or lift: Q YES BLDG. CONSTRUcnON TYPE: (>lo<"}<- OCCUPANCY CLASSIFICATION: Q..e...A-c....:..l
TYPE OF CONSTRUCTION: TY OVEMENT: PROJECT INFORMATION:
M COMMEROAL 0 ~ ~ Early Release /'
1'- (Privately owned hospItalS and medICal /Yi::J AD Grgl?f 'It C Permit: Y......N
offices/centers are commercIal) ,..;:;:,t::fJ.,. S~o~<'I OA, -z.
o INSTITUTIONAL "I, y iH.'11) I)Ce w.'V.s~SPlit: _Y _N Sump Pump:
o MUniCipal/Public Bldg O~ ~ ~~~\?' ~~itl) <'1// U('.,.
o School ! R~iI)7l'7!ij~<I/ Co ~9Yi~AREA DESIGNATlONCSl FOR THIS PROPERTY:
o Church NEW ~'fitr~ fVy O'e$. <'IlJO/1
o MULTI-FAMILY ACCES .s~A $
Number of Units: _ 0 DETACHE ~)iE "'0 v.~
' 0 ATTACHED GARi@E /1t/p ING CONTRACTOR:
FOUNDATION TYPE: (Chec~ all whIch 0 CELL TOWER (New) V. 'Ii;.
apply for the new construction area) 0 CELL TOWER CO-LOCATE 'j:J
o SLAB 0 CRAWL SPACE 0 DEMOLmON Plumber's Indiana State License #:
o POST&_BEAM _PIER 0 BASEMENT (WALKOUT:_Y_N)
Manufactured
Trusses:
-~-5f:
_y.-LN
Class I structute 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 requested by
this application will comply with, and conform to, all applicable laws of the State of Indiana, and the ~Zoning Ordinance of Carmel Indiana - 1993" (Z~ 289) and amendments,
adopted under authority of r.c. 36,7 et seq, General Assembly of the State of Indiana, and all Acts amendatory thereto. I further certify that only kitchen, bath, and floor dr?ins are
oonn1Z;O e sanit s r. I funher certify that the construction will not be used or occupied until a Ccrtifirnte of Occupancy or SubscantiaJ Completion has.'been
iss ,ed y th ep of Com icy Services, Carmel, Indiana. /'
. \...G--V' \S-::.", r:;7 - Jo- 61
Signature 0 Owner or Authonzed Agent Date
INSPECTIONS REQUIRED:
Upper Footing
(Date)
OFFICE USE ONLY: ****************
Rough ~Base
Reviewed/Approved: Dept. of ommunity Services
S:Permits/FormS/ILP COMMEROAL
Date