HomeMy WebLinkAbout07100119 ApplicationCity of Carmel/Clay Township Permit #:?
RESIDENTIAL IWROVEMENT LOCATION PERMIT APPLICATION
;xo?can ?' For Single Family, Town Home, & Two Family: New Structures, Additions, Remodels, & Accessory Structures
BUILDER
OF NAME. PHONE:
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Zi > - 5a- FAX:
2OS`9
RECORD: STREET ADDR S: CITY:
' STATE:
E/ ?1 ZIP:
7 -(la
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BUILDER's EMAIL ADDRESS:
------------------------ BEST METHOD OF CONTACT:
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PROPERTY NAME: ?- PHONE: FAX: i
OWNER
;
STREET ADDRESS: CITY: STATE' ZIP'
LOCATION LOT #: %X SUBDIVISION NAME:- f
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? SECTION:
I ZONING:
PROJECT
&
INFO: /q?
ADDRESS OF CONSTRUCTION: ' ?•? ' y `V
c SQUARE
FOOTAGE:
3 1
2 17 (?? r r. "'pU
SEWER UTILITY C r I??t
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ER WATER UTI
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PROVIDER: O A OF CONSTRUC
' UE) TION: •)
22( . d OQ,
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PROVID
:
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NAME OF UTILITY EXCAVATION CONTRACTOR; PLAN COMMISSION / BZAI BPW D
IFZA
ERMIT #•S V
.+
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O?QMD1 15
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NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC P C?
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FLOOD ZONE AREA DESIGNATION(S) ?AC',Q?' _• YA ?L #'
-?a?77 ?C-1
FOR THIS PROPERTY:
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TYPE OF CONSTRUCTION:
CS?NGLE FAMILY
o TOWN HOME
? TWO FAMILY
# of units being
constructed at this
time:
0 RESIDENTIAL (For
Additions. Remodels, Etc.)
bk OO MPROVEMENT:
-14EW STRUCTURE
? ROOM ADDITION(S)
(] PORCH ADDITION(S)
? DECK ADDITION(S)
? REMODEL
_ Basement Finish only
O ACCESSORY BUILDING
? DETACHED GARAGE
O ATTACHED GARAGE
O DEMOLITION
LUMB G CONTRA OR:
C
! l= S,? : ?ti C? 9?8?i4s
Plumber's Indiana State License #:
Which plumbing codes will be applied to the construction:
(emationai Residential Code w/Indiana Amendments
O Uniform Plumbing Code w/Indiana Amendments
PROJECT INFORMATION:
Early Release /
Permit: _Y
Lot Split: -Y -N
Manufactured
Trusses: N
Sump Pump: Y_N
FOUNDATION TYPE: (Check all that apply for the new
construccd n area)
(J CRAWLSP?ACEE ? POST & _ BEAM -PIER
0"SLAB O- BASEMENT (WALK0UT:_Y_N )
For Single Family and Two Family dwellings, additions, remodels, and/or accesso" structures, this permit is valid only if construction commences within 180
days of the date of issuance of the building permit, and most be completed (Certificate of Occupancy issue i f the issuance date. Class I
structure permits are subject to the General Administrative Rules of the State of Indiana (See 675 LAC 12) e t?ti beginning and
completing construction.
I, the undersigned, agree that any construction, reconstruction, enlargement, relocation, or ahemtion of a stmt any change in the use of Ta structures
requested by this app6atior. will comply with, and conform to, all applicable laws of the State of Indiana, and th ???rrtt5555 o4f C?ya?yr,?mel I .a-1993' (Z-
239) and amendments, adopted under authority of LC, 36-7 et sec, General Assembly of the State of Indiana, and rs=1r Lfftrtr7 I f certify that only
kitchen, bath, aid floor drains are connected to the sanitary sewer. I further certify that the construction will of be used or occupied until cote of
Occupancyhas been issued by the Departrnent of Community Services,C,aarrrm?el, Indiana- By
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Sj?batum of owner ?r Authorized I&SW Date
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OFFICE USE ONLY:
Filing Fees:.
Base Inspections: charged Re-
?7 Reviews
Cert. of Occupancy: 5 ??Ly?'yy
P.R.I.F.: / f I9/ (llf Additional Fees
Fee Received by:
S:Pe.WFono5/ILP RESIDENTIAL