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City of Carmel/Clay Township Permit #: 7f 1
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, & Two Family: New Structures, Additions, Remodels, & Accessory Structures
BUILDER of NAME PHONE
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STREET ADDRESS CITY STATE ZIP
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BUILD/ERf'S? EMAIL ADDRESS / BEST METHOD OF CONTACT'
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PROPERTY NAME PHONE
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OWNER: -
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STREET ADDRESS CITY STATE ZIP _35
LOCATION LOT# SUBDIVISION NAME
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INFO: ADDRESS OF CONSTR4C[IOON '?
/oD7 T r?I??O?LLO Y'$71A,/ * SQUARE
FOOTAGE:
SEWER UTILITY
PROVIDER: / WATER UTILITY
PROVIDER: ar on,"e- ESTIMATED COST OF CONSTRUCTION:
(EXCLUDING LAND VALUE) 5O0 COO.
NAME OF UTILITY EXCAVATION CONTRACTOR; PLAN COMMISSION / BZA / BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #5 (IF APPLICABLE]:IG'J?1rJI?
TYPE OF CONSTRUCTION:
CK SINGLE FAMILY
O TOWN HOME
O TWO FAMILY
# of units:
O MULTI-FAMILY
# of Units:
O RESIDENTIAL (For
Additions, Remodels, Etc.)
TYPE OF IMPROVEMENT:
0 NEW STRUCTURE
O ROOM ADDITION(S)
O PORCH ADDITION(S)
O REMODEL
O ACCESSORY BUILDING
O DETACHED GARAGE
O ATTACHED GARAGE
O DEMOLITION
PLUMBING CONTRA GG U U
Plumber's Indiana State nsrg
which plumbing codes will be a
O International Residential Code w/Indiana Amendments
91 Uniform Plumbing Code w/Indiana Amendments
(Multi-Family Construction Code)
PROJECT INFORMA TION:
FOUNDATION TYPE:
Early Release (/ Manufactured construction area)
Permit: _Y _N sses: _Y XN
Lot Split: Y ` N Sump Pump:Y _N O CRAWLSPACE
O SLAB
Does any part of the property lie within a special Flood designation area: _Y _N (Check all that apply for the new
O POST & BEAM
Q5- BASEMENT
wADCOUT:_Y X 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, 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 com lecM construction.
1, the undersigned, agree tlac any construction, reconstruction, enlargement, dh)3a?Pas the use of land or
structures requested by this application will comply with, and conform to, all 45EP.ja lpy cam, ?pn g ordinance of Carmel
Indiana -1993' (Z-289) and amendments, adopted under auchoniy of LC. 36-7 ec? seq G?m?I Sac Acts amendatory
thereto. I further certify that only Idtchen, bath, and floor drains are connect a an e?? Q&at the construction will not be
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used or occupied until a Certificate olOccupancf, has been issued by the r1l
Owner or Authorized Agent
)FFICE USE ONLY: ******************
SPECTIONS UIRED:
Upper Footing Lower F . _ Under Slab
Rough Meter se Final Si
YTOWNSHIP 9-907
Dam
Filing Fees: C/
Base Inspections: # Charged Re-
Reviews
Cert. of Occupancy: J S ?G
P.R.I.F.:
V Additional Fees
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Reviewed/Approved: Dept. of Community Services (Date)
S:PerrnWFOrnWILP RESIDENTIAL