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City of Carmel/Clay Township Permit #: 7O
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
s an?.j For Single Family, Town Home, & Two Family: New Structures, Additions, Remodels, & Accessory Structures
BUILDER
F NAME: /? PHONE
/ ?V I FAX?f O/ YZ Z- y
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RECORD: STREET ADDRESS: cm?
rrca< 01 STATE: ZIP:
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BUILDER'S EMAIL ADDDJ,?ESS: / BEST METHOD OF'CfO?7.R-Cf:
PROPERLY NAME' PHONE: FAX:
WNER
:
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STREET ADDRESS: CITY: RELEASED FOR CON
ST
RZUCTI
LOCATION
PROJECT LOT IONN E:
2?? ) "?
/z ` " t?Od.' nCE
t nd Lo f?
1I
120N?IY?eO? lotions
al Cod--?
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INFO: /
1 17 ADDRESS CONSTRUCTION* C f CITY F (R,9EL (`.
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SEWER UTILITY
PROVIDER: ? [
£I/ V WATER UTILITY
ROVIDER:
r
I
CO n
ESTIMATED COST V OF k
(EXCLUDING LAND VALUE) U
/- G
NAME OF UTLITY D(CAVATION CONTRACTOR; PLAN COMMISSION / BZAI BPW DOCKET
NTY WELL AND/OR SEPTIC PERMIT #S (IF APPLICABLE):
/ L{
NUMBERS; TAC DATE(S ); AND/OR COU G2 ( dN
FLOOD ZONE AREA DESIGNATION(S) TAX MAP PARCEL #:
FOR THIS PROPERTY: (-
TYPE OF CONSTRUCTION:
0 SINGLE FAMILY
C ?"TOWN HOME
O TWO FAMILY
# of units being
constructed at this
time:
0 RESIDENTIAL (For
Additions. Remodels, Etc.)
PROJECT INFORMATION:
Early Release
Permit: _Y N
Lot Split: Y N
TYPE OF IMPROVEMENT:
C: P STRUCTURE
CD ROOM ADDITION(S)
PORCH ADDITION(S)
O DECKADDITION(S)
? REMODEL
_ Basement Finish only
? ACCESSORY BUILDING
O DETACHED GARAGE
? ATTACHED GARAGE
O DEMOLITION
Manufactured
Trusses:
Sump Pump:
=-y -N
Y '?/
N
PLUMBING CONTRACTOR: '.p
lava ? AiGO?
Plumber's Indiana State Lice a #: Q'
J r2 q??
Which plumbing if applied tothe whktrluction:
D Uniform
construction
Code w/Indiana
apply for the new
Q CRAWLSPACE ? POST & _ BEAM -PIER
Q--SGB ::3 BASEMENT (WALKOUT:--Y---97)
For Single Family and Two Family dwellings, additions, remodels, and/or accessory structures, this permit is valid on]), if construction commences within 180
days of the date of issuance of the building permit, and must be completed (Certificate of Occupancy issued) within IS months of the issuance date. Class I
structure permits are subject to the General Administrative Rules of the State of Indiana (See 675 IAC 12) regarding expiration time frames for beginning and
completing construction.
1, the undersigned, agree that any construction, reconstructon, enlargement, relocation, or alteration ola structure, or any change it. the use of land or structures
requested by -.'ms application will comply witi, and conform to, all aopbcable laws of the Sate of Indiana, and the -Zoning Ordinance of Cannel Ir6isna-1991 (Z-
239) and amendments, adopted under authority of I.C. 36.7 et seq, General Assembly of the State of Indiana, and all Acts amendatory thereto. I further terrify that only
knc Ten, bath, and floor drains are connected to the sanitary sewer. I further certify that the construction will not be used or occupied until a CeralicAte of
Occu has keen issu d by a Department of Community Semce?C7armel. Indiana
Sig. .Km of Owner or Authorla Agee print pare
OFFICE USE ONLY: **************************************:*:******::><?=:fi==
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SPECTIONS REQUIRED: Filing Fees:
? rf
Upper Lower Footing nder Base Inspections: R
Cert. of Occupancy: I SS
Fee
# Charged Re-
Reviews
Additional Fees
n
Date