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CITY OF CARMEL / CLAY TOWNSHIP PERMIT # 13oL1'0173'
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION Sewer / Water;Utility
. ., Far.New Structures,Additions,Remodels„and Accessory,Structures Permit#
moimo,BUILDER` NAMcj PHONE FAX
,
OF IC4AFL SAePe2 ?II :;ZgL-S I'(,� 717-- 252-'57/ 5
RECORD STREET ADDRESS CITY - STATE ZIP
1oL1 1 6DScu& W (AP- c te,/ c,co 3z
E-MAIL ADDRESS BESIIMETHOD OF / ( p
' CONTACIr,. t I Z -7_, sO7 L tcyv
PLUMBING 'NAME STATE OF INDIANA: / PLUMBING CODE
CONTRACTOR. LICENSE NUMBER
4 CRC O UPC
PROPERTY NAME 'PHONE; FAX
OWNER Sew L ,
'Lull��q�-�
STREETADDRESS'A i If _E IfFrk ifi STATE ZIP
i
SPc I r (C 1 D( 252013 ffliiAPROJECT LOT NUMBER SUBDIVISION NA ddn SECTION
LOCATION .2-3
STREET ADDRESS � -. CITY STATE ZIP
SAS 6t s 411\4
tz
TAX MAP PARCEL'NUMBER. - m a. FLOOD ZONE/S
I7-,13 -D"9 -o1 - 06-:0,03 _ a0a 5-2; X.= uhtlladtd
LOT SPLIT SEWER'UTILITY WATER UTILITY -- - -= SEWER/WATER
q YES t/NO C?'fiwb CAR.in et; UTILITIES EXCAVATOR.
TYPE OF TYPE OF CONSTRUCTION MASTER PERMIT FLOORPLAN
t.
PERMIT ISINGLE FAMILY 0 TWO FAMILY Q TOWNHOME 0 YES 0 NO
TYPE OF IMPROVEMENT rt IG , EARLY RELEASE
0 NEW,STRUCTURE Wy ❑ REMODEL, ❑ ATTACHED GARAGE ❑'',.ACCESSORY,BUILDING
0 ADDITION 0 Roorn/s O Porch LIDeck 0 BASEMENT FINISH U DETACHED GARAGE q DEMOLITION ❑ YES NO
PROJECT SQUARE FOOTAGE
PLAN COMMISSION./BZA/BPW.DOCKET NUMBER/S��AND/
OR ESTIMATED COST
TACDATE/S F �^ I r�
PDF PLANS TYPE OF FOUNDATION MA' ' I •Er SUMP PUMP PORCH
❑;CD 0 E-MAIL 0 SLAB q BASEMENT-q WALK-Q_T - TRUSSES / /
[I CRAWLSPACE ❑ POST&BEAM 1G POST&'PIER ❑`YES 13 NO,7t��QQ�� O YES trNO /YES q NO
STATE OF CDRNUMBER RELEASE DATE CONSTRUCTION \VDCCUPANCY CLASS
•
INDIANA (.0-/ V'''CDR. SCOPE OF RELEASE �(�- (.0-/ a\\tn TYq F RELEASE
FOR TOWNHOMES O FDN, O'STR q ARCH_.q 'ELEC'q -MECH q PLUM O wr `iQT PCe _ e ,�w \O•
For Single Family and TWO Family Dwellings this permit is valid only if construction Lcpi Atl!s thi1t`th •days of the of issuance of this permit and
;must be completed,having the Certificate of Occupancy issued,within 18 mont - t tlee'.ytbl Itp•r �{aas I Structure Permits are subject to the State
'of Indiana General Administrative Rules(GAR 675 IAC 12)regarding expiration `ti or,b' g and completing construction.
,1,the undersigned,agree that any construction,reconstruction,enlargement;r ion or alteration of a structure,or any change in the use of land or
structures requested by this application will comply.with and conform to all app tcable Uws of the State of Indiana and the`Zoning Ordinance of Carmel
(Indiana-1993"(Z-289)-and amendments,adopted under authority of I.C.364:of segi General Assembly of the State of Indiana,and all Acts amendatory
thereto. 1 further certify only kitchen,Bath,andBoor drains are mnnectedto the sanitary sewer. 1(urther certify that the construction will not be
used o oc upied 1 a Certificate of Occupancy has been issued,by.the Department of Community Services,Carmel,Indiana:
wt\ Mc t�r��� SaP���- Si l zsf�
Signature Owner or Au wised Agent Printed Name _Date
t REQUIRED BASE INSPECTIONS *, PERMIT FEES
* Filing/Review
Rddriional!inspecti s may be repined. / Re-Review
Base Inspections / •CX)
❑ Lo -r:Footing Rough-In 'F ✓ �(j
Cert.of Occupancy Other
;, Upper Footing ❑ Meter Base •Site p.R:IF. •
❑ Underslab h Ob
/' , _{ TOTAL _ es ,
rR ,
it- aces,. ,� Fee R /, - - • 06
3
'Reviewed/Rele d Department of Community Se ec u d Department of Community 5 rvmes Date
_
B:Nermu.\FormsiApplicanonsSRevidendallILP AppIicauout2009-0b Last Updated 08/13/2009