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__ Permit #: _ . COMMERCIAL/INSTITUTIONAL/MULTI-FAMILY IMPROVEMENT LOCATION PERMIT APPLICATION (For New Structures, Additions, Remodels, Tenant Finishes, & Accessory Buildings) City
ofCarmel/Clay Township BUILDER OF RECORD: PROPERTY OWNER: LOCATION & PROJECT INFO: NAME: V f\.~.jv PHONE: FAX: LIe. <fSlj 7/7 CITY: STATE: ZIP: z c;J//BEST METHOD OF CONTACT: A,.,/;
PHONE: FAX; STATE: ZIP: ~ SUITE #: (If Applicable) i .... U %" :5-/SCOPE(S) OF o ARCH 0 MECH 0 RELEASE: 0 OTHER(S): _ WATER UTILITY SEWER UTILITY ESTIMATED COST OF CONSTRUCTION: . ..1
PROVIDER: PROVIDER: (EXCLUDING LAND VALUE) ~ /[) PLAN COMMISSION /BZA /BPW DOCKET NUMBERS; AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'S (If Applicable): # of Floors: Elevator or Lift:
q YES q NO BLDG. CONSTRUCTION TYPE: OCCUPANCY CLASSIFICATION: TYPE OF CONSTRUCTION: TYPE OF IMPROVEMENT: G3'" COMMERCIAL o NEW STRUCTURE (Privately owned hospitals and medical o ADDmON
offices/centers are commercial) o Room(s)o INSmUTIONAL o Porch o Municipal/Public Bldg o Mezzanine or Deck Deck o School o REMODEL o Church o NEW TENANT FINISH o MULTI-FAMILY o ACCESSORY
BUILDING Number of units: o DETACHED GARAGE o ATIACHED GARAGE FOUNDATION TYPE: (Check all which o CELL TOWER (New)apply for the new construction area) [13'" CELL TOWER CO-LOCATE o SLAB
o CRAWL SPACE o DEMOLmON o POST& BEAM __PIER 0 BASEMENT (WALKOUT:_Y_N) PROJECT INFORMATION: Early Release Manufactured Permit: __V __N Trusses: _Y_N Lot Split: __V N Sump Pump: __Y_N
FLOOD ZONE AREA DESIGNATIONCSl FOR THIS PROPERTY: PLUMBING CONTRACTOR: NY Plumber's Indiana State License #: Class I structure permits are subject to the General Administrative Rules
of the State of Indiana (See 675 lAC 12) regarding expiration time frames for beginning and completing construction, I, the undersigned, agree that any construction, reconstruction,
enlargement, relocation, or alteration of a structure, or any change in the use ofland or structures requested by this application will comply with, and conform to, all applicable laws
of the State of Indiana, Indiana, and the 'Zoning Ordinance of Carmel Indiana -1993" (Z-289) and amendments, adopted under authority of I.e 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 ofOccupancy orSubstantial Completion has been issued by' Department of Co m~nity Services, Carmel, Indiana. R.4.v7>'/rl74,e.f1"7l2'1eL
. Fv:z-·b...oe w,':'i'le>:s A(.f(\l'f' . /;2/ylzcf' Print ' Date OFFICE USE ONLY: ************************************************************************ INSPECTIONS REOUIRED: Filing
Fees: o Upper Footing 0 Lower Footing # Charged ReBase Inspections:o Under-Slab 0 Rough-In Reviews o Meter Base 0 Final Building Cert. of Occupancy:o Final Forestry 0 Final Fire Dept.
Additional Fees*NOTE: Above ceiling/grid inspection requirements will be TOTAL: indicated on your permit placard. ~' Reviewed/Approved: Dept. of Community Services (Date) Fee Received
by: Date S:Permils/Forms/ILP COMMERCIAL Aug.2DD?