HomeMy WebLinkAbout07100112 ApplicationI1;c r
?IxoiaxaF/City of Carmel/Clay Township
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Permit #: 107 (bin I i ?-
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Town Home, & Two Family: New Structures, Additions, Remodels, & Accessory Structures
BUILDER NAME: / PHONE: FAX:
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RECORD: STREET ADDRESS: CTY: STATE: IIP:
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BUILDER'S EMAIL ADDRESS: ST METHOD OF CONTACT:
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PROPERTY NAME: PHONE: FAX:
OWNER:
STREET ADDRESS: CITY: SPATE: ZIP:
LOCATION LOT d: SUBDIVISION NAME: SECTION:
k /67,r
- 4 ZONING:
& PROJECT V '
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INFO: ADDRESS LOF CONSTRUCTION:
7 ?3 ?,C?r?t ?n dlI K ? SQUARE 7 /
FOOTAGE: y b
SEWER UTILITY
PROVIDER: C'r/t aefa WATER UTILITY ESTIMATED COST OF CONSTRUCTION: e1p
PROVIDER: COQ ???/ (EXCLUDING LAND VALUE) 2? 00(/,.
NAME OF UTILITY EXCAVATION CONTRACTOR; PLAN COMMISSION / BZA / BPW DOCKET
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NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT I'S (IF APPLICABLE): Q C,`?, \
ROOD ZONE AREA DESIGNATIQ51f5) j D FOR
FOR THIS PROPERTY: a T 7' II
P eddTpS(?TIOQoO TAX MAP PARCEL
0- 01 16
TYPE OF CONSTRUCTIORT ?i} tFf lations PLUMBS CONTRACTOR: 'PJC?
Iq]1NGLE FAMILY CITY OF CA ICES q-`r Sw1 1-4 ? .o
O TOWN HOME ?j Plumber's Indiana State License #: -y
O TWO-FAMILY O)f{(¢(}C SHIP, ?y ,
IfION(S) ?,7?
# of units being ON
constructed at this O REMODEL W
time: Basement Finish only Which plumbing codes will be applied to the construction:
O RESIDENTIAL (For O ACCESSORY BUILDING Intemational Residential Code w/Indiana Amendments
Additions, Remodels. Etc.) O DETACHED GARAGE O Uniform Plumbing Code w/Indiana Amendments
O ATTACHED GARAGE
PROJECT INFORMATION: O DEMOLITION FOUNDATION TYPE: (Check all that apply for the new
Early Release Manufactured construction area)
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Permit: Y - Trusses: • YEN ET CRAWLSPACE O POST & _ BEAM -PIER
Lot Split: Y -cXl?1- Sump Pump: !ter -N gQ LAB f?EMENT (WALKOtIT:_Y ' N )
For Single Family and Two Family dwellings, additions, remodels, andlor accessory structures, this permit' ences within 180
days of the date of issuance of the building permit, and must be completed (Certificate of Occupancy iss f? hji, -!R § t 9 , cc date. Class I
structure permirs are subject to the General Administrative Rules of the State of Indiana (See 675 LAC I2) '(t$.?'tpti time r beginning and
completing construction.
I, the undersigned, agree that any construction, reconstruction, enlargement, relocation,, or alteration of a scuct r ar n 1tQQ =1I 1- rs=C:ures
requested by this application will comply with, and conform w,, ll applicable laws of the State of Indiana, and th I n ininft a -1993' (-
239)and anendments, adopted under acthorty-ofI.C36-7 et segGenertl Assembly of the State of Indiana and e tsamendatory:hereto. Ifurthe certify that only
kitchen, bath, and Poor dzcls arc con netted m the sanita-ery sll further certify that the construction will t be used or occupied until a C - 'rsre of
Occupancyhas been issued by the epartment of C no city senices, Carmel, Indiana By
Fe 771
Signs) re of Dwner or Auth ' /gent / P m Date
**xxxx*?**** x****xxxxxsxxxxxx****x****x*xxxxxxxxxx**xxxxx*x*xxxx*xx****x***x*xxx
OFFICE USE ONLY:
NSPECTI DIRE/ Filing Fees:
Base Inspections: * Charged Re-
pper Foot in Lower Footi Under Slab Reviews
Cert. of Occupancy: ?s-
ough In Meter Base Final site
n 1 P.R.I.F.: 00. Additional Fees
Reviewed/Approved: Dept of Community Services (Date)
S:Pe.WForms/ILP RESIDENTIAL Fee Received ov:
Date