HomeMy WebLinkAbout07080090 Application
City of Carmel/Clay Township Permit #:~
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Town Home, &. Two Family: New Structures, Additions, Remodels, &. Accessory Structures
BUILDER
OF
RECORD:
NI' lLr-e
l t59DOESS: I'J
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BUll ER'S EMAIl ADDRESS:
, DAtJNE. Srle:Pt-IER../J
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PHO~i'5 ;l35D >( dObFAX:
CITY: ~ STATE:
~T CAr2A-{ EG
ZIP:
'1dJ3J-.
P BEST METHOD OF CONTACT:
iUXG ' W'n E-mAIL!
PROPERTY
OWNER:
NAME:
PHONE:
FAX:
STREET ADDRESS:
CITY:
STATE:
ZIP:
LOCATION
&. PROJECT
INFO:
, SECTlON:
T 6U.ALFOw:). Sk,
ZONING:
S-.1
Dt2...
SQUARE '\"
FOOTAGE: d!:il..o 3
SEWER UTI WATER UTIUlY
PROVIDER: PROVIDER: CU\
NAME OF UTILITY EXCAVATION CONTRACTOR; PLAN COMMISSION I BZA / BP DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'5 (IF APPLICABLE):
ESTIMATED COST OF CONSTRUcnO
(EXCLUDING LAND VALUE)
5
Early Release
Permit:
,...-/
_Y_N
_Y --.k:N
A - 1 SUlY:J2_LOQ. l:: X C
TAX MAP PARCEL #:
Ar:/ I --30' 03.03 OSAf .000
TYPE OF IMPROVEM€~eCI'Q~OP.WIIl;BING CONTRACTOR:
~EW STRUCTUll!'_ - o~o COf17p/;,,/"' CO~~XlI'VI <1--. So ~ ~
o ROOM ADDIT.JON(S), 0 Slnr(Pfu'1Jlle~s'iffilla!l~ EMJi.0fvse #:
o PORCH ADDU,tON(S) F COIl ~ Cel C~' "((JI./!. IJI-..
o DECKADDITION(SyFC"R' '''M{I^/J..... "<!!B~ rv1)O I 0 \
o REMODEL '" t>1i":::) , . .. '~
B t F. . h I Whidi e.!.lImP"n iYWf..be. applied to the construction:
_ asemen 1015 any I^f-t:::.,~- V-\ 7'"n "'\""l::~~
o ACCESSORY BUILDING . ~tema ioh"'~ I Code w/Indiana Amendments
o DETACHED GARAG' ~I\ UP l ."1 . fllJ .
o ATTACHED GARA' \lP':' , 0 UnIform Plumbing Coife wI IndIana Amendments
o DEMOLITIONrJ,l 0 \... .
r ~ FOUNDA!lON TYPE: (Check all that apply for the ,new
Manufactured construction area)
Trusses: ..............y _N
Sump Pump: ....,y _N
A~M~~~
BEAM _PIER
FLOOD ZONE AREA DESIGNATION(S)
FOR THIS PROPERTY:
TYPE OF CONSTRUCTION:
o SINGLE FAMILY
C>Y'TOWN HOME
o TWO FAMILY
# of units being
constructed at this
time:
o RESIDENTIAL (For
Additions~ Remodels. Etc.)
PROJECT INFORMATION:
Lot Split:
:_Y_N)
For Single Family and Two Family dwellings. additions, remodels, and/or accessory structures, this pe
days of the date of issuance of the building pennit, and must be completed (Certificate of Occupancy
structure pennits are subject to the General Administrative Rules of the State of Indiana (See 675 lAC
completing construction.
I, the undersigned, agree that any construction, reconstruction, enlargement, relocation, or alteration of a st se of 1 d or structures
requested by this application will comply with, and conform to, all applicable laws of the State of Indiana, and the UZoning Ordinance 0 a diana -1993" (Z~
289) and amendments, adopted under authority of LC 36-7 et seq, General Assembly of the State of Indiana, and all Acts amenwtOlY thereto. I further certify that only
kitchen, bath, and floor drains are connected to the sanitary sewer. I further certify that the construction will not be used or occupied until a Certificate of
Occupancyh'-S been j"ued the Departm~7unity Services. Carmel. JDA-N JJ c -S.1dE;:2cJff..D 'i?h I 01
Print Date I
s v'A~1</l'11 ifft""lff/iUftio
d) Wltl1Wl m rlloM1Mbfth
) regarding expiration time
enees within 180
anee date. Class I
s for beginning and
ONLY:*********************************************************************************
Filing Fees: &' () (J. 3 0
--::/ ~ 7. ,d
55.)0
/ J 'I dO
. (JI c;JcJ b ?f So
/ j.. ; j!all4 ?J,~?l~7
Base Inspections:
# Charged Re-
Reviews
Cert. of Occu pa ncy:
P.R.I.F.:
Additional Fees
Reviewed/Approved: Dept. of Community Services
(Date)
TOTAL:
~~l" 17
S:Permits/forms/ILP RESIDENTIAL