HomeMy WebLinkAbout07080023 Application
City of Carmel/Clay Township Permit #: 076~ro~8
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Town Home, &. Two Family: New Structures, Additions, Remodels, &. Accessory Structures
SEWER UTILITY WATER UTIllTY
PROVIDER: p PROVIDER: C R
NAME OF UTIlITY EXCAVATION CONTRACTOR; PLAN COMMISSION / BZA I BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'S (IF APPLICABLE):
BUILDER
OF
RECORD:
PROPERTY
OWNER:
LOCATION
&. PROJECT
INFO:
NAME:
D
STREET ADDRESS:
flOOD ZONE AREA DESIGNATION(S)
FOR THIS PROPERTY:
TYPE OF IMPROVEM NT:
TYPE "F CONSTRUCTION:
rJt" SINGLE FAMILY
o TOWN HOME
o TWO FAMILY
# of units being
constructed at this
time:
o RESIDENTIAL (For
Additions. Remodels. Etc.)
,
FOUNDATION TYPE: (Check all that apply for the new
construction area)
o CRAWLSPACE 0 :TWt+lQIlkAM ~PIER
,,~F~MQ~M~t\ll,y ~)
For Single Family and Two Family dwellings, additions, remodels, and/or accessory strucp.1rAAo\~~W ~r4?I\!Dlf~, '. ~Ii~~6es wit$n ISO
days of the date of issuance of the building pennit, and must be completed (Certificate optJcaipan:;'e~ ~~ril\ l~~," H .~l~ s~u~1ip" class I
structure pennits are subject to the General Administratl,'ve Rules of the State of Indiana (See 675 IA Gl:i)"~~!a~".il~Q. Ili~, '", ~~, '~ing and
completingconstructionoEPl ~ I C~'\' ,j~'
I, the undersigned, agree that any construction, reconstructIOn, enlargement, relocation, or altera~p~fl'l@:ik~ 1ij~~iI\.. th~,'U,s~:~qa!1~, ',0, r str1;lctures
requested by this application will comply with, and conform to, all applicable laws of the State GWi\nb:;'and the "Zon\ ~brlU.of S:~rmel)ridiana.':-'1993" (Z~
289) and amendments, adopted under authority of LC 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 drains are connected to the sanitary sewer. 1 further certify that the construction will not be used or occupied until a Certificate of
OC upancy has been issued by the Department of Community Services, Cannel, Indiana.
.. . .
I..CRI Ii, p,; RbSoJJ(;-Jh.IIl/;/JE
NEW STRUCTURE
o ROOM ADDITION(S)
o PORCH ADDITION(S)
o DECK ADDITION(S)
o REMODEL
_ Basement Finish only
o ACCESSORY BUILDING
o DETACHED GARAGE
o ATTACHED GARAGE
o DEMOLmON
PROJECT INFORMATION:
Early Release
Permit:
Lot Split:
_v 4,
_V~N
4-N
-.y.V _N
Manufactured
Trusses:
Sump Pump:
OFFICEUSEONLY:******************************~~*********************~********2J*****************
INSPECTIONS REQUIRED: FIling Fees: !0~ (1~O
er Footing ~FOO~ Under Slab Base Inspections: d if1, :5 0 # C~:~~::;;s Re-
Cert, of Occupancy: 0- ') :).
~ter~ ~ Sib; ) J
~ P.R,~,: ~ I cT- C I 00 ,Additional Fees
~~,_; _',",,~"~",_~ ~~LP?.57M(J
l. "~,'m;"'Fo'm';IlP RESIDENTIAL Fee Received bv: Date:
Print
i'd'
CITY:
STATE:
ItJ
ZIP:
410:)76'
FAX:
ZIP:
i./,;lq
s-
SQUARE
FOOTAGE: 5, :J
ZONING:
ESTIMATED COST OF CONSTJtUCTION:
(EXCLUDING LAND VALUE) II ~:l3 DO
Whi~lumbing codes will be applied to the construction:
cM"Intemational Residential Code w/lndiana Amendm~nts
o Uniform Plumbing Code w/lndiana Amendments
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