HomeMy WebLinkAbout05050080-Application ~' ~r'O~/~Sh~,~ Permit #:
IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, & Two Family: New Structures, Additions, RemodelS, &A~ry StrUCtUres
BUZLDER of
NAHE
PHONE FAX
BUILDER'S EMAIL ADDRESS
BEST ME'~OD OF CONTACt:
PHONE FAX
LOCATZON
PR~E~
INFO: ROD~SS OF CONSTRUCTION
PROVIDER: ( V~ ~_.~ ..l. FKUViDbK: ~,
NA~E OF UTILITY EXCAVATION CONTRACTOR; PLAN COMMISSION / BZA / BPW DOO(ET
NgMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PER~IT #'S (IF APPLICABLE):
~: TYP R N :
[] SINGLE FAMILY [] NEW STRUCTURE
[] TOWN HOME [] ROOM ADDITION(S)
[] TWO FAMILY [] PORCH ADDITION(S)
# Of unit~:, [] REHODEL
C] MULTI-FAMILY [] ACCESSORY BUILDING
# of Units:____ [] DETACHED GARAGE
(For
Additions, Remodels, Etc.) [] .,,ATTACHED GARAGE
L~ DEMOLITION
P A :
Early Release Manufactured
Permit: Y __~N Tresses: __Y _~N
Lot Split: ___Y_~ Sump Pump: ___Y ~
FOOTAge: 72 oo
ESTIMATED COST OF CONSTRUCTION____~,"
(EXCLUDING LAND VALUE)
PL NG CTOR:
Plumber's Indiana state
Which plumbing codes will be;
[] International
(MulU-Famil$
~J[~[~L~L~: (Check all f~t apply
construction area)
[~/CRAWLSPACE [] POST & BEAM
[] SLAB ~BASEMENT
Does any part of the property lie within a special Flood designation area: Y N WALKOLff: Y N
For Single Family and Two Family dwellings, additions, remodels, and/or accessory structures, this permit is valid only ff construction commences
within 180 days of the date of issuance nf the building permit, and must be completed (Certificate of Occupancy issued) within 18 monks of the
issuance date. Class I structure permits are subject to the Gtmeral Administrative Rules of the State of Indiana (See 675 1AC 12) regarding expiration
time frames for beginning and completing construction.
I, thc undersigned, agree that any construction, reconstraction, enlargement, ~]ocation, or alteration of a structure1 or aiay cha~ge in the use of land or
su:uctures requested by this application ~ comply with, and conform to, all applicable laws of the State of Indiana, and the 'Zoning Ordinance of Carmel
Indiana - 1993' (Z-289) and amendments, adopted under authority of I.C. 36~7 et seq, General Assembly of the State o£ 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 occupicd/~ntil a Cevrit"Jcat'¢ of Occupancyhas been issued by the Depar truest of Community Services, Cannel, IndMrm.
5--//
Signatur~'of O~mor or Authorized Agent - ~ ~ Da~e
OFFICE USE ~)NLY: ************************************************************************
INSPECTIONS REQUIRED:
Upper Footing
Services
Filing Fees:
Base Inspections:
# Charged Re-
Reviews
Cert. of Occupancy:
Site P.R.I.F.: AddiUonal Fees
(Date) ~