HomeMy WebLinkAbout05080278-ApplicationCity of Carmel/Clay Township permit #:~
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, & Two Family: New Structures, Additions, Remodels, & Accessory Structun~s
PROPERTY
OWNER:
STREET ADDRESS
PHONE
, 17-5q ,0
~O~E
LOCAT/ON LOT # SUBDW~SION NAME SECTION
& PRO3ECT __ ~ _
TNFO: ~OeESS OF CONS~UCnON
~NTRACTOR; PLAN COMMISSION / BZA / BPW
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPAL PE~ WS (~F APPLTCA~: ~, :__. -. -:
~ ; I- :N: TY - FIM R-V -: NT: ~NTRACTO__~
[] SINGLE FAMILY [] NEW STRUCTURE
[] TOWNHOME ~ ~,:-:~,~ ~ ROOMADD~TION(S) Pluml~er's Indiana State Uceese #:
[] TWO FAMILY .............. : ~ii t:'oRcH ADDITION(S)
#of units:__ ~,~b ~:; ~' ~' ~'~:~EMODEL
[] MULTI-FAMILY {Z~] ACCESSORY BUILDING Whlchpl.mbin. codeswl, beapplie~t~
#ofUnits: ~:'~'~ [] ];~,q~AC. HEDGARAGE E~ ZntemaUonal
[] RESIDENT~AL(For[y ~.~:~
Additions, Rem~o~e~s, ~'~cl.) j /:~ i ~ ~:~_~ /_~ED GARAGE
i~:[;(~9[i_F[ON [~ Uniform Plumbing
(Multi-Family C
ZIP
ZONING:
Early Release Manufactured
construction a
N Trusses: Y N
Lot: Split: Y N Sump Pump: Y N ~ SLAB
Does any part of the property lie within a special Flood designation area: Y _N
For Single Family and Two Family dwellings, additions, remodels, and/or aeeer~ory structures
w/thin 180 days o£ the date of/ssuance of the 18 months of the
issuance date. Class I structure permits are subject to the General Administrat/ve Rules of th~ of Indiana (See 675 IAC 12) xegarding exp/ration
time frames for beginning and completing ennstruction,
I, the undersigned, agree that any construction, reconstruction, enlargement, relocation, or alteration of a structure, or any ~th~ e/n the use of h~d or
swactures requested by this applicataon will comply with, and conform to. all appUcable hws of the State o£indiana, and the Zon/ng Ordinance of Canad
indiana - 1993~ (Z~28.9,) and amendments, adopted under authority of LC. 36~7 et seq~ General Assembly of the State of indiana, and al/Acts amendatory
thereto. I further certify that onfy kitchen, bath. and floor drains are connected to the sanitary sewer. I further certify that the construetinn will not be
cyt~s beexs issued by the Depaxamaent of Community Services, Carmel, Indiana.
$lg~r or Aul~odzed Agent ~r~n~
OFFiLE USE ONLY.' *******************************************************/ ~ ***************
C, I~,,,~ Filing Fees:
XNSPECTXONS REQUXRED: ~ [~51~~
Upper FooUng Lower FooUng Under Slab
Rough In Meter Base Final P.R.I.F,:
. TOTAL:
~muniht
Charged R~--
Reviews
Additional Fees