HomeMy WebLinkAbout07100040 Application-:gym ca-??
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City of Carmel/Clay Township
,0210 Permit#: ?o1?
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Town Home, & Two Family: New Structures, Additions, Remodels, & Accessory Structures
ILDER NA PHONE:
C - - rf0 -"7761
3
7 FAX:
OF 1
C .
RECORD: STREET ODRESS: CITY:
c? lvd S? STATE:
r ZIP:
BUILDER's EMAIL ADDR
EZ:: BEST METHOD OF CONTACT:
RE
p t% G O/ t -/F4C1
PROPERTY NAME: PHONE: FAX:
OWNER f? nd" C - -3
:
STREET ADDRESS: CTtY:
76 v? 11C b' STATE:
el ZIP:
d
LOCATION
PROJECT LOT #: SU SION E. r
;2 S_ 1, ! e o7C 0,zs-- 5 ON:
tics ZONING C
u
&
INFO: ADDRESS OF CONSTRUCTION: -
D h?erc?a- Sf r m e / FOSQUARE
OTAGE:
OaFs
SEWER UTILITY
PROVIDER: n
Q WATER UTI LITY
PROVIDER: rlne/ ESTIMATED COST OF CONSTRUCTION:
(EXCLUDING LAND VALUE)
EF
NAME OF UTILITY EXCAVATION CONTRACTOR; PLAN COMMISSION / BZA / BPW D=
L
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'S (IF APPLICABLE): &u U ri
FLOOD ZONE AREA DESIGNATION(S) TAX MAP PARCEL #:
FOR THIS PROPERTY:
TYPE OF CONSTRUCTION:
SINGLE FAMILY
? TOWN HOME
? TWO FAMILY
# of units being
constructed at this
time:
? RESIDENTIAL(For
Additions. Remodels, Etc.)
PROJECT INFORMATION:
Early Release
Permit: Y ?N
Lot Split: _Y _?( N
For Single Family and Two I=
days of the date of issuance of
structure permits are subject to
TYPE OF IMPROVEMENT:
NEW STRUCTURE
? ROOM ADDITION(S)
O PORCH ADDMON(S)
? DECK ADDITION(S)
O REMODEL
_ Basement Finish only
O ACCESSORY BUILDING
O DETACHED GARAGE
O ATTACHED GARAGE
O DEMOLITION
Manufactured
Trusses: _Y X_
Sump Pump;,
LU BING CONTRACTOR:
/'/7/h CST ? ?nS
Plumber's Indiana State License #:
10000101
Which plumbing codes will be applied to the construction:
WIntemational Residential Code w/Indiana Amendments
0 Uniform Plumbing Code w/Indiana Amendments
FOUNDATION TYPE: (Check all that apply for the new
construction area)
{'CRAWLSPACE O POST &BEAM -PIER
O SLAB BASEMENT(WALKOUT:_Y3N)
this
I, the undersigned, agree that any coowu.?re?pq, bl-ement, relocation, or alteration of astn
requested by this application will i >® 111671 nu 1 ?ble la,,s of the State of Indiana, and
289) and amendments, adopter urdi I oriry of L_C; T A eneral Assembly of the State of Indiana, m
kitchen, bath, and floor d:aL-is are connected to the sanitay sewez. I further certify that the construction w
Occupancyltas been issued by the Department of Community Ser?lces, C
6-
Date
OFFICE USE ONLY: INSPECTIONS RE UIRED: Filing Fees: FQ? b _U
Base Inspections: ?6 '? # Charged Re
U er Footing wer oting Under Slab Revie'w's
Cert. of Occupancy: S S ??
Rough In Meter Base Final site
10-10-07
Reviewed/ oved: Dept, of Community Services (Date)
S:Permlttltorms(RP R NTTAL
P.R.I.F.:
/ 261 00
ces within 180
date. Class I
kcts amendatory tbmto. I "er certify, that
be used or occupied until a uTicate of
Additional Fees
7