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BUILDER STREET CITY STATE ZIP
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TENANT NAME
(if applicable)
W NAME PHONE
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STREET
CITY
STATE ZIP
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LOCATI? LOT SUBDIVISION (:57./ ? ? SECTjOI?`
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ADDRESS OF C
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Improvement Location Permit Permit No.
Township Date 10-11,
Roll File
This permit is valid only if construction is started within 120 days of issuance date; all construction is completed (c/o issued) v
years of issuance date unless an extension of time has been officially granted by letter by the Director, Department of
Development.
A. TYPE OF CONSTRUCTION
1.0 Residential (One or Two Family)
2.0 Residential (Multi-family)
3.0 Commercial
4.0 Industrial
5.0 Institutional
B. TYPE OF SEWAGE DISPOSAL
1.0 Public (Name of System )
2.0 Private (Septic Tank, etc.)
C. TYPE OF WATER Or- LAj
1.0 Public System (Name of System )
2.0 Private (Well )
D. TYPE OF 1IMPROVEMENT
1.0 New Stucture
10 Commercial Tenant Space
3.0 Addition Porch Room _
4.0 Remodel
5.0 Foundation Only
6.0 Demolition
7.0 Accessory Building
8.0 Swimming Pool
9.0 Garage Detached Attached
E. ZONING CLASSgICf TION OF PROPERTY
Present II
F. PRESENT USE OF PROPERTY
1.0 Farm/Vacant
2.0 Residential (One or Two Family)
3.0 Commercial
4.0 Industrial
5. 0 Other (Specify)
G. PROPOSED USE OF PROPERTY
1.0 One or Two Family Dwelling
2.0 Multi-family
3.0 Commercial/ Industrial
4.0 Other (Specify)
H. ESTIMATE COST OF CONSTRUCTION_ Z.2 z
(Excluding Land Value)
1. Lot Split: Yes No
J. Flood Zones: Yes No
K. Sump Pump: Yes No
L Geothermal Heat Pump: Yes No
M. Manufactured Trusses: Yes- - N _ _
N. Plumbing Contractor/ CODE: OVA r CABO
Plumbing
The undersigned agrees that any construction, reconstruction, enlargement, relocation or alteration of structure, or any change in the use
of land or stuctures requested by this application will comply with, and comform to, all applicable laws of the State of Indiana, and the
"Zoning Ordinance of Carmel, Indiana -1980", adopted under the authority of Acts of 1979, Public Law 178 Sec. 1 et seq, General A4 pembly
of the State of Indiana, and all Acts amendatory thereto.
i further certify that the construction will not be used or occupied until a certificate of occupancy hAs been issued by the-Department of
Community Development, Carmel, Indiana. w •
Of s t" .....
I further certify that only kitchen, bath, laundry and floor drains are
Inspections Needed:
Drainage Site
tv tt __ r` Square Footage
; it (Sq. Footage) ..................... do
De a e C mmunity De to mefit Jtls ctions ....................................
p
C W14cate of Occupancy .............. 1
l ?. Tof?l...................... ...........................
By A?_?-Pfan Comm./BZA Docket #