HomeMy WebLinkAbout07100110 ApplicationF. II D
City of Carmel/Clay Township Permit #: ot7l O O
COMMERCIAL/INSTITUTIONAL/MULTI-FAMILY IMPROVENIENT LOCATION PERMIT
APPLICATION (For New Structures, Additions, Remodels, Tenant Finishes, & Accessory Buildings)
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BUILDER
OF NAME: \ PHONE:2 FAX:
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RECORD: STUFFT ADD S: : STATE: ZIP'
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BUILDER'S Eh L ADORES$;,A
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coym BEST METHOD OF CONTA('FI
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PROPERTY
OWNER: NAME:
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EET DDRESS: ( 049 CITY: STATE: ZIP:
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LOCATION A S OF COi QN:_ _ ^
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INFO: Address of Shell Building: (if different than Address of Con cdon) Lct # and Subdivision: (If Applicable)
Bl. L _ G ROIECF, OR TENANT. NAME:
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-(/ ZONING:
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TAX MAP PARCEL
COMMERCIAL
STATE
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DESIGN RELEASE #:S U
1 ARCH MECH ?LUM
SCJ?E(S) OF -Y FDN W,,/ SIR ?
RELEASE: ')? ELEC O SPKLR OTHER(S): SQUARE
FOOTAGE: U OtZ
WATER UTILITY
PROVIDER:
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??? SEWER UTILITY
PROVIDER: C? ESTIMATED COST OF CONSTRUCTION:
(EXCLUDING LAND VALUE) 3 OD DO C)
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MBBERS; AND/OR
DOCK
ET
PLAN COMMISSION/ BZA / BP
COUNTY WELL AND/OR SEPTIC PERMIT #'S (I f Applicable):
# of Floors: Elevator or Uft: _7 YES ? 1 NO BLDG. CONSTRUCTION TYPE: OCCUPANCY CLASSIFICATION: _ a
CY COMMERCIAL 11 ;YVl IKULIUKt
(Privately owned b an ne ill F01133 ON
offices/centers are menial) Room(s)
O INSTITUTIONAL %CT 1.2 NO, Porch
O Municipal/ & Meaanine or Deck
O School O REM DEL
O Church By 17-71 NEW IIENANT FINISH
O MULTI-F,Q?LY L_j RY BUILDING
Numbelr6C.hta&ASF=FOR CONISJTPL6' ?_fH®NARAGE
ND ON E?e(L(fiecK all ?niFtitih'O vtiii it r L TOWER (NRAGE
ew)
apply r the new constfvctlortfirea)1 LGC3 T? C CELL TOWER CO-LOCATE
sLAB DEPTC? F yl,, ec rIT??bS-?FrD?€M??d(fir?i??c&yp
0 POST&C B CAIERC E3 `BASEMINYT(vvAlKOUI! Y_N)
Early Release Manufactured
Permit: _Y L`N Trusses: _Y XN
Lot Split: _Y X Sump Pump: _Y _XN
FLOOD ZONE AR DESIGNATION ) FOR THIS PROPERTY:
V /?/ISC?(JC
PLUMBING CONTRACTOR:
IAfmm r Setts ?lUm1?,,Xo
na State
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s Indta
Plum ense SF:
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Class 1 structure permits are subject to the General Administrative Rules of the State of Indiana (See 675 LAC 12) regarding ea-piration time frames for beginning and
completing construction.
I, tAe undersigned. agreethat any construcfion, reconstrac^on,eniargement,rdceatiom ar al[etazion of as atp[[??,,,,yL?$$$FFF oegs s¢u m??jtsrequ<sted hp
chn.pplicationwdl comply with, andeenformce,allapphcablela,sof the State oflndiana,andthe'Zo' O. I()diPta$ ty, g@menclrnm ,
urr adopted under aurhoriLy of I.C. 36-7 a seq, General Assembly of the Stare of indiana, and all Acts a-nendatc r t?IIlSy't?gatj"td??eee777????2h71 tj7oor drains art
connected cc " sanit sewer. I further certify chat th struetion will not be used or occupied until a Certificate ofoccupanty orSuhsvntia/ Completion has been
issued byt ep ---of Community Semces, ,Indiana
S)n.1?J1?S9? 101 ??
Sig of tlwnr or AaM"W Agent Print Dale
OFFICE USE ONLY: x**x***x****x***xx*x***x*x**x*xxxxxx:::s=a a a =__
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INSPECTIONS REQUIRED:
Upper Footin Lower Footin Under Slab
It.
of Community Services
Filing Fees:
Base Inspections:
Cert. of Occupancy:
TOTAL:
Fee RECE W:
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