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City of Carmel/Clay Township Permit #: V I ll?l ?O
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Town Home, & Two Family: New Structures, Additions, Remodels, & Accessory Structures
BUILDER
OF NArte: " PHONE:
I °`il ar ations
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RECORD: STREET ADDRESS: r-- CDY -o.^, t?„;? STATES S ZIP:
10+2-4 >
BUILDERS EMAIL ADDRESS: BEST, METHOD OF CONTACT:
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PROPERTY NAME: PHONE:
SO ?A?SG?7L S?S=8Y?iU. FAX:
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OWNER
:
STREET ADDRESS: CITY: STATE:
/4-o4)6 Z /rsecoc_J ?T. C z- ZIP:
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LOCATION LOT SUBDIVISION NAME: SECTION:
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5 ZONING: 6e I/
PROTECT D
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INFO ADDRESS OF CONSTRUCTION: SQUARE
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: /? a fo f3 i& 20 c- D c_ FOOTAGE:
SEWER UTILITY
G
/ WATER UTILITY
OVIDER ESTIMATED COST OF CONSTRUCT
(EXCLUDING LAND VALUE)
$z
ION
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PROVIDER: ( :
PR OQ
NAME OF UTILITY EXCAVATION CONTRACTOR; PLAN COMMISSION / BZA / BPW DOCKET
IF APPLICABLE):
ERMIT #S D (7 f2 (YI I?
C
l?Ji C u L
(
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC P ,
FLOOD ZONE AREA DESIGNATION(S)
IS PROPERTY TAX MAP PARCEL Y:
SEr G 5 200
:
FOR TH
TYPE OF CONSTRUCTION: TYPE OF IMPROVEMENT: PLUMBING CONTRACTOR: I
By
C1 SINGLE FAMILY G NEW STRUCTURE N J?
O TOWN HOME o ROOM ADDITION(S) Plumbe/s India a State License #:
? TWO FAMILY (PORCH ADDITION(S)
# of units being O DECK ADDITION(S)
onstructed at this O REMODEL Which plumbing codes will be applied tD the construction:
time: Basement Finish only
RESIDENTIAL (For _
o ACCESSORY BUILDING O International Residential Code w/Indiana Amendments
Additions, Remodels, Etc.) O DETACHED GARAGE D Uniform Plumbing Code w/Indiana Amendments
O ATTACHED GARAGE
PROJECT INFORMATION: O DEMOLITION
?
Pl FOUNDATION TYPE: (Check all that apply for the new
y construction area)
red
Early Release /Manufactured ((//
Permit: Y ?fJ sses: _Y _ N
O CRAWLSPACE x POST & BEAM -PIER
Y v//N N
Lot Split: _Y _ Sump Pump: _ )
O SLAB O BASEMENT (WALKOUT:--Y
For Single Family and Two Family dwellings, additions, remodels, andlor accessory structures, this permit is valid only if construction commences within 180
davs of the date of issuance of the building permit, and must be completed (Certificate of occupancy issued) within 18 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.
I, the undersigned, agree that any construction, recommiction, enlargement, relocation, or alteration of a structure, or any change in the use of land or structures
requested by this application will comply with, and conform to, all applicable laws of the State of Indiana, and the "Zoning Ordinance of Carmel Indiana -1993" (Z,
289) and amendments, adopted under authority of LC 36-7 et seq. General Assembly of the State of Indiana, and all Acts amendatory Hereto. I further terrify that only
kitchen, bath, and poor drains are connected to the sanitary sewer. I further certify that the construction will not be used or occupied until a CerrOcate of
Oc bee ec?by theD of CommunityServi-/,;ay tlmel,Indiana.
f/}/J ?// / csMCL IvIa Fekt)--?
signature of owner or AUdWdq?d Agent Print Date
****x**xx*x*xx****x****x****xxxxx='==>'____`__++_-_--
OFFICE USE ONLY:
INSPECTIONS REQUIRED: Filing Fees: 3 e
Base Inspections: 22 SQ # Charged Re-
pper Footin Lower Footing Under Slab Reviews
Cert. of Occupancy:
ough In eter Base inal Site
P.R.I.F.: q Additional Fees
9y???7 TOTAL. ?d
Fee Received bY: Date