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Permit #:
09
,,OF ^ City of Carmel/Clay Township
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Town Home, & Two Family: New Structures, Additionsr Remodels, & Accessory Structures
BUILDER
OF NAME: PHONE: FAX:
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RECORD: STREET ADDRESS: CIT.':
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BUILDER'S EMAIL IADDRESS* 11 11
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PROPERTY NAME: PHONE: Uf St 'E; and LO^'c des.
OWNER LQJt? 3/ IU- r r Imp c G
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STREET ADDRESS: CITY:
A sY CI OF C'ARMEE7:CLAY
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LOCATION ?( BDIV15?ON?AME:
LOT
JJ SECTION: ZONING:
PROJECT /
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INFO: ADDRESS OF CONS7RUCT10 : FOSQUARE
OTAGE:
SEWER UTILITY /n WATER UTILITY
VIDER ESTTt-0ATED COST OF CONSTRUCnON: }I[/ ?,
(EXCLUDING LAND VAWE) !f? J v' Q?
PROVIDER: r(/ :
PRO
NAME OF UTILITY EXCAVATION CONTRACTOR; PLAN COMMISSION / BZA / BPW DOCKET
NTY WELL AND/OR SEPTIC PERMIT #'S (IF APPLICABLE
O
U
NUMBERS; TAC DATE(S); AND/OR C
ROOD ZONE AREA DESIGNATION(S)
t
FOR THIS PROPERTY j
I T
f ,1 7
fAU(G
2 4 200l
:
TYPE OF CONSTRUCTION:
G SINGLE FAMILY
? TOWN HOME
? TWO FAMILY
# of units being
constructed at this
time:
O RESIDENTIAL (For
Additions, Remodels, Etc.)
PROJECT INFORMATION:
Early Release
Permit: _Y
Lot Split: _Y jN
TYPE OF IMPROVEMENT:
O NEW STRUCTURE
? ROOM ADDITION(S)
O PORCH ADDITION(S)
DECK ADDITION(S)
? REMODEL
_ Basement Finish only
u ACCESSORY BUILDING
O DETACHED GARAGE
O ATTACHED GARAGE
O DEMOLITION
Manufactured
Trusses:
Sump Pump:
Y -N
Y N
PLUMBING COST CTOR:
By -
Plumbers Indiana State License
Which plumbing codes will be applied bD the construction:
O International Residential Code w/Indiana Amendments
O Uniform Plumbing Code w/Indiana Amendments
FOUNDATION TYPE: (Check all that apply for the new
construction area)
O CRAWLSPACE eT' POST & _ BEAM -PIER
O SLAB ? BASEMENT (WALKOU T:_Y_N) _
For Single Family and Two Family dwellings, additions, remodels, and'or accessory structures, this permit is Valid only if construction commences within 180
days of the date of issuance of the building permit, andmust becompleted.(Certificate of Occupancy issued) within 18 months of the issuance date. Class I
structure permits are subject w the General Ad . , is ative Rules of the State of-Indiana (See 675 LAC 12) regarding expiration time frames for beginning and
completiagco I coon.
I, the undersigned, agree chat any cons[ruc" n, reconstruction, enla Dement, relocation, alter ation of a s -ucture, or any change in the use al land orstructures
requested by this application will compl vith, and conform to, all applicable lws [fIe S to of Indiana, and the "Zoning Ordinance of Cannel Indiana -1993' (?-
2 89) and amendmen ts, adopted under [hority of LC. 36-7 et seq, General Assaemblyofof th State o_ Indiana, and all Acts amendatory thereto. I further certify that only
]dtchen, bath, and Tloor drzins are co netted w th sa ita_y sewer- I further certify, t/Y/-" a construction will not be used or occupied until a Certificate of
Occupancyhas a issuedbyt epartment f unity Senices, Carmel, I.
t /? U 'VIA
ori.e D e
OFFICE USE ONLY:************************,****
INSPECTIONS REQUIRED:
Upper Footin Lower Foo '' Under Slab
Rough In Meter Ba Fin I F Site
?Z? b7
S:Pwo,ita? O m;''.tP RESIDENTIAL
Filing Fees: _
Base Inspections: ?h GC m Charged Re-
Cert . of Occupancy: -SS Reviews
P.R.I.F.:
I ? L?
Fee ReceiveC bY:
Additional Fees
if