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City of Carmel/Clay Township
BUILDER NAME: PHONE: FAX:
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RECORD: STREET ADDRESS: CITY: STATE: ZIP:
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S' t'BIi1LDER'S.EMAILiA4RRErSS:.?"' " N BEST METHOD OF CONTACT:
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PROPER
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LOCATION LOT #: SUBDIVISION NAME: SECTION:
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INFO: ADDRESS OF CONSTRUCTION:
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FOOTAGE: ?-$ 7
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SEWER UTILITY WATER UTILITY O? h / ESTIMATED COST OF CONSTRUCTION:
PROVIDER: G? (Li;?? O
PROVIDER: C L!L (EXCLUDING LAND VALUE) ??j dZGT'8
NAME OF UTILITY EXCAVATION CONTRACTOR; PLAN COMMISSION / BZA I BPW DOCKET p
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IF APPLICABLE
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NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SE
FLOOD ZONE AREA DESIGNATION(S) TAX MAP P
FOR THIS PROPERTY: , ( %?
TYPE OF CONSTRUCTION:
SINGLE FAMILY
TOWN HOME
? TWO FAMILY
# of units being
constructed at this
time:
0 RESIDENTIAL (For
Additions, Remodels. Etc)
PROIECTINFORMATION:
Early Release /
Permit- _Y N
Lot Split: _Y ?N
TYPE OF IMPROVEMENT:
NEW STRUCTURE
ROOM ADDITION(S)
O PORCH ADDITION(S)
? DECK ADDTRON(S)
O REMODEL
_ Basement Finish only
O ACCESSORY BUILDING
O DETACHED GARAGE
O ATTACHED GARAGE
O DEMOLITION
Manufactured
Trusses: _Y ? N
Sump Pump: X," Y_N
F-11 Uniform Plumbing Code w/Indiana Amendments
construction area)
of/201V6
Permit #:
(Chedc all that apply for the new
Q CRAWLSPACE ? POST & _ BEAM -PIER
O SLAB C* BASEMENT (WALKOUT:-V-Y_N )
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For Single Family and Two Family dwellings, additions, remodels, and/or accessory structures, this permit is valid only if construction commences within 180
days of the date of issuance of the building permit, and must be completed (Certificate of Occupancy issued) within 18 months of the issuance data' Class l
structure permits are subject to the General Adm irustrative Rules of the State of Indiana (See 675 LAC I Ing expuatiom.time frames for beginning and
completing construction.
I. the undersigned, agree that anv construction., recor strumon. enlargement, relocation, or alteration o a srructure. m any change in the\of land or structures
requested by this application will comply with, and conform to, af) applicable laws of the Stare of Indiana, and the "Zoning Ordinance of Carmeldndiu.a - 1993" (Z-
239) and amendments, adopted under auchoriV of I.C. 36-7 cc seq, General Assembly of the State of Indiana, and all Acts amendarory thereto I further certify that only
kitchen, bath, and doordrains are connected to the sanitary sewer. I further certify that the construction will not be d or occupied untila erti6care o!
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Occupancyhas been issued by the Depamnent of Community Services, Carmel, Indiana.
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Signature of owner Authorized Agent Print D
***********************x*x*************************. [-***** **************:*
OFFICE USE ONLY:
INSPECTIONS REQUIRED: Filing Fees:
Base Inspections: 7 UQ' # Charged Re-
Upper Footin wer Foot in nder Slab/ Reviews
Cert. of Occupancy: S5 ? ?
Rough In Meter Base final Site
P.R.I.F.: ?Q Additional Fees
TO L•
Reviewe / roved: De munity Services (Date) ? /'?j
S:Perml yiLP FESiDENi L
Fee Received bv: ? Date
PLUMBING CONT TOR:
Plumber's Indian State License D ? 1
Which plumbing codes will be applied to E _on:
O International Residential Code w/Indiana Amendments
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Town Home, & Two Family: New Structures, Additions, Remodels, & Accessory Structures