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BUILDER
OF
RECORD
CITY OF CARMEL / CL,AY TOWNSHIP PERMIT #
COMMERCIAL/INSTITLITIONAL IMPROVEMENT LOCATION PERMIT APPLICATION
For New Strucfures, Additions, Tenant Finisl�es, Remodels, and Accessory Structures
NAME PHONE FAX
PLUMBING I NAMN�Qi�
CONTRACTOR �
PROPERTY
OWNER
PRO]ECT
LOCATION
LO75PLiT
❑ YES O NO
TYPE OF
PERMIT
EARLY RELEASE
❑ YES ❑ NO
PRO7ECT
PDFPLANS
❑ CD ❑ E-MAIL
STATE OF
INDIANA
CDR
S�'u�✓��uC... 't�l"�"�O?J�1
CITY
� i��
BEST MET OD OF
CONTACT
✓� C�
S7ATE OF INDIAN�
A�j� l LICENSENUMBER
�G�i�S ��-��" i• PHONE
:�l{-��. '�n1�e- _ r_
�/, c�OTM�
�I d:+/.�tiC7 CQ.�/
COMPLE%AND/OR BUILDING�,�A
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SU17E NU BER v CIrv
WATER UTIIITY
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30`� �i '9� °' 0 ����
STA7E ZIp
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4 �
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PAX
o (� �3' ifb�-O
S7ATE 2Ip
' L�
NUMBER OFFLOORS ELE�VAT/pR
� L[Y YES ❑ NO
STATE Zip
EXCAVATOR
�COMMERCIAL ❑ INSTITUTIONAL-❑Municipal/PublicBUilding ❑SChool ❑Church
TVPEOFIMPROVEMENT
❑ NEW STRUCTURE ❑ NEW TENANT FINISH O ATTACHED GARAGE
❑ ADDITION - ORoom/s OPOrch ODeck L�REMODEL ❑ DETACHED GARAGE
PLAN COMMISSION / BZA / 6PW DOCKET NUMBER/S AND/OR ES7IMATED COS7
TAC DA7E/S OFCONSTRUC7fON �
�SLAB�"' � � ❑ �BASEMENT-❑ WALK-OUT
CRAWLSPACE ❑ POST & BEAM ❑ POST & PIER
RNUMBER RELEASE DATE
EXCLUDING LAND � �'
MANUFACTURED
7RUSSES �/
� YES Llff NO
SCOPE OFRELEASE ❑ HOOD
❑ FDN ❑ STR ❑ ARCH O ELEC ❑ MECH � PLUM ❑ SPKLR O OTHER
Number of Units
❑ MULTI-FAMILY
O ACCESSORY BUILDNG O CELL TOWER
❑ DEMOLITION � CO-LOCATE
SQUAREFOOTAGE
� D� �5
SUMPPUMP PORCH
❑ YES L7N0 ❑ YES L7 NO
OCCUPANCY CLASS
TYPE OF RELEASE
Class [ structure permits are subject to tlie State of Indiana General Admiuistrative Rules (GAR G75 IAC 12) regarding
expiration titne fra�nes for beginning aud co�n��letiug constrttetion.
I, H�e undersigned, agree tLat any constructio�y reconstrnction, enlargement� relocatio�y or alteration ofa strnen�re, or any change iu the i�se oFlaud or
strimti�res reqnested by this a���ilicatiou will comply with and conforin to all applicable laws of the State of h�diana aud tlie "ZOning Ordivance of Cannel
Lidiana- 1993° (Z289) and amendments� ado�rted tuider nutl�ority of I.C. 36-7 et se9� General Assembly oFU�e State of Indiana� and all pcts amendatory
thereto. I furf6er certify that o�ily kitcLen� bath� and �lom� drains are counected to the sanilary atwer. I fnrther certify that N�e constrnction will not be
nsed or pecu��icd until a CertiGcate of Occu��ancy or of Substantial Com�iletion has becn issned by the Deparhnent oFCommuuity Services� Carmel� Ind'ana.
y`�1� -� �en�,� +� .� ��
SlgnahreofOwnerorAUthorize Agent PrintedNam� Date
......................................................................
REQLIIRED BASE INSPECTIONS *
* Additional inspections may be required.
❑ Lower rooting
❑ Upper Footing
❑ Undcrslab
❑ Roug6-In ❑ Fire
❑ Meter Base ❑ Forestry
❑ Final ❑ Site
; Revicwed/Rcicascd-Deparhne��tofCommnnity5ervices
� ..............................................................
'ennils\POnns\Applirnlions\Realdenliul\ILP Applicolion�2010-09
Datc
: PERMIT FEES
E Filiug / Review
: Base Ins��ections
: Ccrt. of Occupancy
9 P.R.I-.F.
TOTAL
� FceReceivcd-De�»rt�nentoFComnwnitpSen•ices
Re-Review
Other
Dam
Lxs�Updamd 01/10/13