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City of Carmel /Clay Township Permit #: O$O I O (? ?'
RESIDENTIAL RvIPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Town Home, & Two Family: New Structures, Additions, Remodels, & Accessory Structures
BUILDER NAM PHONE:
21 7 172- 071-16 FAX:
3/7 72 0 17 10
OF
RECORD. STREET ADDRESS: CITY: STATE:
1 '? W g S 7- oC /? v ZIP:
Y6 2446
BUILDER'S EMAIL ADD ESS: BEST METHOD OF CONTACT:
PROPERTY NAME. PHONE:
L
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S
F- 9
J 8/7-
? 11
2
53 10 FAX:
OWNER: ,
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7
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CQ
STREET ADDRESS: CITY: STATE:
-JJ 7
ld ZIP:
g?l c,
LOCATION LOT *: SUBDIVISION NAME: SECTION:
1
J ZONING: 11
I
& PROJECT ®rt a
2 y.
INFO: ADDRESS
13cr OF CONSTR 6, UCTION: G7'
4GL//G_tJ- t
SQUARE
FOOTAGE: C!?
SEWER UTILITY
PROVIDER: LT R w WATER UTILITY
PROVIDER: ESTIMATED COST OF CID
(EXCLUDING LAND VALUE)
NAME OF UTILITY EXCAVATION CONTRACTOR; PLAN COMMISSION I BZA I BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT *'S (IF APPLICABLE): LU
l{ r 2 9 -zo I C`
FLOOD ZONE AREA DESIGNATION(S) TAX MAP PARCEL #:
FOR THIS PROPERTY: By
TYPE OF CONSTRUCTION:
O SINGLE FAMILY
? TOWN HOME
C TWO FAMILY
# of units being
constructed at this
time:
RESIDENTIAL (For
Additions. Remodels. Etc.)
Early Release
Permit: _Y N
Lot Split: _Y -7N
? NEW STRUCTURE
O ROOM ADDITION(S)
O PORCH ADDITION(S)
DECK ADDITION(S)
REMODEL
6- Basement Finish only
Manufactured
N
Trusses:
Sump Pump: jY Y ? N
? A CESSORY BUILDING
? DETACHED GARAGE
C ATTACHED GARAGE
? DEMOLITION
PLUMBING CONTRACTOR:
9'L 1'J PIO h rh s'
Plumber's Indiana State Li se #o:
Tf 2 00 m 0 Yedo
Which plumbing codes will be applied to the construction:
? International Residential Code w/Indiana Amendments
Uniform Plumbing Code w/Indiana Amendments
FOUNDATION TYPE: (Check all that apply for the new
construction area)
O CRAWLSPACCE O POST & _ BEAM -PIER
? SLAB IJ BASEMENT (WALKOUT:_Y (---N )
For Single Family and Two Family dwellings, additions, remodels, and/or accessory structures, this permit is -, slid only if c inn ences within 180
days of the date of issuance of the building permit, and must be completed (Certificate of Occupancy issued t - e date. Class I
structure permits are subject to the General Administrative Rules of the State of Indiana (See 675 1 W-unes for beginning and
completing construction.
I, the undersigned, agree that any construction, reconstruction, enlargement, relocation, or alterat? r any change in the use of land or structures
requested by this application will comply with, and conform to, all applicable laws of the State of In a, and the "Zoning Ordinance of Carmel Indiana -1993" (Z-
269) and amendments, adopted under authonty of LC. 36.7 et seq, General Assembly of the State of Indiana, and all Acts amendatory thereto- I further certify that only
kitchen, bath, and floor drains are connected to the sanitary sewer. I further certify that the construction will not be used or occupied until a Certificate of
Orcu has been issued by the t of Community Services, Carmel, Indiana. ?J /-I ® ` " A.,rT?Yr: a n Ct-V J -A - OO
Signature of Owner or Authorised Agent Vint Date
OFFICE USE ONLY:
INSPECTIONS REQUIRED:
Upper Footing Lower Footing Under Slab
Rough In Meter Base Final Site
r / '2
Reviewed/Ap roved: Dept. of Community Services (Date)
S:Permits/Fom s,/:LP RESIDENTIAL
Filing Fees:
Base Inspections:
Cert. of Occupancy:
CC% # Charged Re-
Reviews
P.R.I.F.: ayyIl ? Additional Fees