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City of Carmel/Clay Township Permit #:_MJOULZ?/
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, & Two Family: New Structures, Additions, Remodels, & Accessory Structures
BUILDER of NAME . 1 \ ` PHONE FAX
:
RECORD
STREET ADC S CITY STATE IIP .
BUILDER'S EMAIL ADDRESS BEST METHOD OF CONTACT:
PROPERTY - IdME PHONE FAX
OWNER:
STREET ADDRESS CITY STATE ZIP
LOCATION LOT# 5UBDIVISION NAME A ((??(? pp SFC lOIi (
?(?
1
I
VwS r`(1 ZONING:`)
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& PROJECT pl
\- ; i _ fl 1
Y ?
INFO: ADDRESS OF CONSTRRUCTIO TtArMr SQUARE
FOOTAGE:
UIL 1A
LI'
CONSTRUCITON:
ESTIMATED COST OF
(EXCLUDRJG LAND VALUE)
DR
n
VATION CONTRACTOR; PLAN COMMISSION J SZA / BP1( DOCKET
(S); AND/OR COUNTY WELL ANWOR SEPTIC PERMIT #'S (IF P.PPLICABLE):
TYPE OF CONSTRUCTION: TYPE F IMPROVEMENT: PLUMBING CONTRACTOR:
?n%
!? SINGLE FAMILY NEW g lA' F? k \ i hl
O TOWN HOME O ROOM Plumber's Indiana State L" use #: J
O TWO FAMILY ? pp D DI A
# of units: O A? ?T StatePll?
O MULTI-FAMILY O I Rry y b ill be applied to the con
# of Units: rgL
? RESIDENTIAL (For O DETAC NJ(/ aseb$Jfd
Additions, Remodels, Etc.) ential Code w/Indiana Ar??Ft ?e
O ATTACHED GA F? /C umbing Code wtIndiana Amendments
4 1
C DEMOLITION
i??strudion Code)
PROJECT INFORMATION: A?? v +, _:1
? FOUNDP WIKYPE: (Check all that apply for the new
Early Release Manufactured
IZ??L .?eonsti?cjion area)
Permit: Y N Trusses: V Y 1
Lot Split: _Y VIN Sump Pump: o Z I `? RE? OMWLSPACE O POST & BEAM
-N 5Lg8 O BASEMENT /
Does any part of the property lie within a speciallFtapd designation area: Y ? N WALKOUT: _Y V N
For Single Family and Two Family dwellings, additions, remodels, and/or accessory strucfdres, this permit is c_ n ¢? o nces
within ISO days of the date of issuance of the building permit, and must be completed (Certificate of Occu ui ) {.1T$ri lm _Syt i(, the
issuance date. Class I structure permits are subject to the General Administrative Rules of the State of Indian e 6754AC 12) regarding e}I?;p ration
time frames for beginning and completing construction. I r n
I, the undersigned, agree that any construction, reconstruction, enlargement, relocation, or alteration of a structure y ethHtlbe in &uttsl?af land) i
structures requested by this application will comply with. and conform to, all applicable laws of *.he hate of Indiana an the'Znnfng Ordinance or'C el
Indiana -1993' (Z-289) and amendments, adopted under authority of I.C. 36-71 et sec, General Assembly of the State Indiana, and A Aces amendato
thereto. 1 further certify that only kirchen, bath, and floor drain= are connected to the sanitary sewer. 1 further cent be
used or occupic4,untfl a errificare ofOccnpancvhas been issued by the Depart(m-err of Community Services, Carmel, Indiana.
?f li 1I?? ?uk? ?c\+f\?k?V?\?\l5 '2:3 O
sign Lure of Ow erg Authorized Agent Print Date
****x**x***x***x*******x******x*********x******x**x*** *x*x**x**x******
OFFICE USE ONLY:
Filing Fees: ?-
INSPECTIONS REQUIRED: Base Inspections: '2 # Charged Re-
Uppag Lower Footing Under Slab
ough` eter Final S e
Reviewed/Approved: Dept. of Community Services (Date)
S:P mitslFO VILP RESIDENTIAL
Cert. of Occupancy: S 5
P.R.I.F.:
AL:
Fee Receivec tv:
Rewews
Additional Fees