HomeMy WebLinkAbout07110172 ApplicationCity of Carmdl Clay T~shtp Permit #: r I
RESIDENTIAL EMPROVEMENT LOCATION PERMIT APPLICATION
,+ro(ako- For Single Family, Town Home, & Two Family: New Structures, Additions, Remodels, & Accessory Structures
BUILDER NAME: T- PHONE:
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OF
RECORD: STREET AR G ESS: /i^ 10 CI E STATE: ZIP:
BUILDER'S EMAIL AD SS: L° c, BEST METHOD OF CONTACT:
ROPERTY
OWNER: =PHONE:,r{ +^
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NAM': r?? ??V . r . `+,U , •tJ
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FAX:
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STREET ADDRESS: QPL; -.r•`al 'yr deg,
q ' q ' ? ?cSio ci/?' ZIP:
LOCATION
& PROJECT SUBDIVISION NAME:
LOT`
17 00 -00 -3 0 „ -' ZONING:
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INFO: ADD 5 F
05r ) f RA RSTRUCTION: ?" f [ U53
117,
SQUARE
FOOTAGE:
SEWER UTILITY
PROVIDER: /
f WATER UTILITY
PROVIDER: ESTIMATED COST OF CONSTRUCT
(EXCLUDING LAND VALUE) I
NAME OF UTILITY EXCAVATION CONTRACTOR; PLAN COMMISSION I BZA / DPW DOOCET
ANDJOR COUNTY WELL AND/OR SEPTIC PERMIT it'S (IF APPLICABLE):
NUMBERS
TAC DATE(S O Q V
J
; );
FLOOD ZONE AREA DESIGNATION(S) TAX MAP PARCEL #: 1
f l 15 ?J
LJ
FOR THIS PROPERTY:
TYPE OF CONSTRUCTION:
O SINGLE FAMILY
0 TOWN HOME
TWO FAMILY
# of units being
constructed at this
time:
RESIDENTIAL (For
Additions. Remodels. Etc.)
PROTECT INFORMATION:
Early Release
Permit: Y N
Lot Split: Y _N
- NEW STRUCTURE
dsAk-RgpMJiw ION(s)
0 PORCH ADDITION(S)
D DECK ADDITION(S)
REMODEL
_ Basement Finish only
ACCESSORY BUILDING
O DETACHED GARAGE
ATTACHED GARAGE
O DEMOLITION ,
Manufactured
Trusses:
Sump Pump:
uction area)
a CRAWLSPACE O POST & - BEAM PIER
;,- SLAB - BASEMENT (WALKOUT-_Y N )
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 16 months of the issuance date. Class I
structure permits are subject to the Gencral Administratir a Rules of the State of Indiana (See 5751AC 12) regarding expiration time frames for beginning and
argement, relocation, or alteration of a structure, or any change in the use of land or structures
applicable lases of the State of Indiana, and the -Zon(ng Ordinance of Carmel Indiana -199r (Ti-
;eneral Assembly of the State of Indiana, and all Acts amendatory thereto. 1 further certify that only
I further certify that the construction will not be used or occupied until a Certificate of
r5A- (-.-1 I-liang.
Pnnt
OFFICE USE ONLY: ******************************
REQUIRED:
Upper Foat .ng ` Lower Footing Under Slab
Rough In Meter Base Final sue ?
Reviewed}Approved: Dept. of community Services (Date)
S?PemA51FonnOLP RESIDENTIpl
Filing Fees:
Base Inspections:
Cert. of Occupancy:
P.R.I.F.:
OtOM+e,?NG CONTRACTOR ?J + IMIM2007
I U
Plumber's Indiana State Lice
Which plumbing codes will be applied to the construction:
El International Residential Code w/Indiana Amendments
Q Uniform Plumbing Code w/Indiana Amendments
(Check all that apply for the new
,? C 1 It-16,- -V-7-
Date
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cc?
`l ? # Charged Re-
Reviews
?55 o
Additional Fees
TOTAL:
00