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BUZLDER of
RECORD:
PROPERTY
OWNER:
STREET ADDRESS
BUILDER'S E~L AqDJ~ESS
City of Carmel~Clay Township Permit #
SIDENTIAL IMPROVEMENT ]
r Single Family, Multi-Family, & Two Family: New Structures, P, ddJtions, Remodels, &Accessory Structures
PHONE ~.
BE~T ~
PHONE
FAX
zip
NAME OF UTILITY EXCAVATION CONTRACI'OR; PLAN COMMISSION / BZ~ / BPW DOCKET
NUMBERS; TAC DA'I~.(S); AND/OR COUNTY WELL AND/OR SEPTIC PERN1T #'S (IF APPLICABLE):
FAMILY
[] TWO FAMILY [] PORCH ADDTHON(S)
# of units:__ [] P-.EMODEL
{~} MULTi-FA.H.ILY
# of Units:__ ED
C~ RESIDENTIaL(For [] Al-FAO.
Additions, Remodels, Etc,)
[] DEMOLI-~ON
Manufactured ~
Tresses: /~, Y N
[] Uniform Plumbing Code w/Zndiana Amendments
(MuiU-Family Construe'don Code)
FOUNDATION TYPE: (Check all that apply for the new
construction area)
[] CRAWLSPACE [] POST & BEAM
Lot Split: []SLAB
Does any part of the proparty lie within a special Flood designation area: Y
For Single Family and Two Family dwellings, additions, remodels, and/or accessory structures, this permit is valid, only ff co. ns .tm~ction commences
within 180 days of the date of issuance of the building permit, and must be completed (Certificate of Occupancy kssued) within 18 m.ontlls o,f th.e
issoance date. Class 1 structure permits are subject to the General Administrative Rules of the State of Indiana (See 675 IAC 12) regarding explrauon
time frames for beginning and completing construction,
st~metures ~,qu, ested by this applicataon will comply vath, and confurm to, all applicable laws of the State of indiana, sud ?t. e Zomng Ordimmce ot Carmel
Indiana - 1993 (Z~289)a~damendments~ad~tedunderauth~rity~fLC.36~7etseq~Genera~Assemb~y~fthestste~fIndiana~anda~Ac~am?~.~dat~ry
thereto. I further certify that ctnly kitchen, bath, and floor drains are connected to the sanitary sewer, I further certify that the ,c. onstrueoon ~ not be
used or ecanpied until a Cetzi~ca£e o£Occapa~cyhas been issued by the Department of Community Services. Carmel. Indiana.
Print Date
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Filing Fees:
INSPECTIONS REQUIRED:
Base
Tnspections:
--~ Reviews
O~ L-j ~ J~,}~ ~}TL~ ~, .~'.Lc: c:& ('~,ot~e,S,' ~'"~c2- ~,, ~90 Additional Fees
~Review : ~ Com~nuni" Services 7DateX