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City of Carmel/Clay Township
Permit #: ® / O (1 01 O Z
RESIDENTIAL EVIPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Town Home, & Two Family: New Structures, Additions, Remodels, & Accessory Structures
BUILDER NAME: -veer
e es PHONE:,i 7 31
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/ / / FAX: 47 I30 7
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RECORD: ADDRESS: r
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BUILDER'S EMAIL ADDRESS: ! I I J
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F BES_TMET(IOD OF CONTACT:
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PROPERTY NAME: I ? I
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OWNER:
STREET ADDRESS: CITY: STATE: ZIP:
LOCATION
& PROJECT LOT SUBDIVISION NAME: I
FP ?q SECTION: ZONING:
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INFO: R"
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SQUARE
FOOTAGE:
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SEWER UTI
OVID R LITI'
RWATER O DEER LFfY
OST OF
(EXCUJDINGESTIMATED VALUE) STFiUCT10N:/)f' I
,1'1b /l.Cd f\W! 11)Jl
NAME OF UTILITY EXCAVATION CONTRACTOR; PLAN COMMISSION / BZA / BPW DOCKET
AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'S (IF APPLICABLE):
NUMBERS
TAC DATE(S) I
J\
I'O,
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FLOOD ZONE AREA DESIGNATION(S) TAX MAP PARCEL #:
FOR THIS PROPERTY:
TYPE OF CONSTRUCTION:
? SINGLE FAMILY
Gy TOWN HOME
C) TWO FAMILY
# of units being
constructed at this
time;
? RESIDENTIAL (For
Additions, Remodels. Etc.)
PROJECT INFORMATION:
Early Release
Permit Y _ N11
Lot Split: _Y - N
TYPE OF IMPROVEMENT:
Fr NEW STRUCTURE
O ROOM ADDITION(S)
? PORCH ADDIRON(S)
O DECKADDITION(S)
O REMODEL
_ Basement Finish only
? ACCESSORY BUILDING
CD DETACHED GARAGE
ATTACHED GARAGE
? DEMOLrTION
Amendments
PLUMBING COKRA,CTOR:
S
Plumber's Indiana State License #:
4hllTI
Which pplumbing codes will be applied to the construction:
temational Residential Code w/Indiana Amendments
O Uniform Plumbing Code
Manufactured i/ I „cJ?
Trusses: L__Y
? " to
Sump Pump: _Y _N g?b1. Ot
apply for the new
BEAM -PIER
)UT:_YN )
For Single Family and Two Family dwellings, additions, remodels, andlor acc ctb'r ?? Is yt. onfy if construction commences within ISO
days of the date of issuance of the building permit, and must be completed (Ce t 2] y, I ht 1B months of the issuance dare. Class I
structure permits are subject to the ?General Administrative Rules of the State _ (See 675 LA.60 'regazding expiration time frames for beginning and
`tp I???tgggccc?Q?,,,,,,hhh???rrr,,, conswction.
I, the undersigned, agree, barat c t?o,II ti?r, "T er 1a:ion, or atrera[ion of a structux, or any change in the use of land or structures
requested by this application will comp yl P with, an co om to, aaaTTT appLLLca?o`le laws of the State of Indiana, and the "Zoning Ordinance of Carmel Indiana -1993" (Z-
2R9) and ainendments, ado d under authority of I.C. 36.7 et seq, General Assembly cf the Sure of Indiana, and all Acts amendatory thereto. I further certify that only
kitchen, bath, and Soor ins are connected to the sanitarv sewer. I further certify that the construction will not be used or occupied until a CerNfxateo
Occ cyhas beets is d by the Department of Community Services, el, ndiana. I_
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SlgaaivreotOnnuorA th Agent Prim Date
OFFICE USE ONLY: xxxx**********************xxxx******xx*xx*****xx***x**x****x***xxx******xxx**
Filing Fees: t
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SPECTIONS REQUIRED:
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# urged Re-
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ons:
ase D
J` Reviews
Cert. of Occupancy: ?
Rough In Meter Base Final Site I
P,R.I.F.: /.. Additional Fees
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Reviewed/Approved: Dept. of Community Services (Date)
S:PermcWFOrms!7r.P RESIOENTIAL Fee ReceNed by: Date