HomeMy WebLinkAbout05030040-Master Permit MASTER PERMZT APPLiCATiON
Builder: Date: __
The unaersigned hereby applies TO the City of Carmel, Permit 5erwces off ce
for an4~i/~,~, ~, ~'] ~ J~,q,~ ^l,ZmPr°~e'men'T bocat[on ~ermit (aLP) ~o~ Lot ~ in (Subdivision
Name) ~~/~,] ~,, The address of this Lot is
The Master Plan File on record with Permit Services is: (Name of Model)
Avol/ca~r hereby agrees ro bu//d the same structure ghat Ts represented/N the
approveo Master Plan F//e on record w/th Permit $¢rv/ces. An), alterat~bp ro
rn/s approved p/an will pequl~e submitt/~ an ~ ~evl~ions to
unoer ?nc ~¢nOITIeS Of perjury (Zndiono ¢od¢ 3§-44-2-~),
o~ of -he information Z hove provld~d ~n tMs Master P~rmlt Application Is truc ora accurate
TO The OeSr Of my Knowl~agc and belief, ~nd that Z hove not knowingly or 'ntentionolly
prowa~o or oml~¢o any Information thgr. Wou/d tend to hide. obscure
D¢~T of Communl~ Services r~g~dtng f~e t~uth of the m~ers
Name (Print) Name or--tufa)
r~arne c~r ~pp,,c~nt o~(PHnt: ' ·