HomeMy WebLinkAbout0002.00 ApplicationCarmel -Clay
Township �� Application for
Improvement Location Permit
This permit is valid only if construction is started within 120 days of issuance date; all construction must be
date unless an extension of time has been officially ranted by letter by the Director, Department of Commi
Permit No. q
Date 1 D
Roll File
issued) within 2 years of is
NAME PHONE
cue F-Acwt �- 2s
FAX
B%-24-�IS
BUILDER
STTATE ZIP
TENANT NAME
' I VeE� Ge
7
(if applicable)
NAME PHONE
S£i 07b—
2579
FAX /�
8 76— ZSfS
OWNER
STREET CrrY
51800-D Nt IC+4IG1\`Q
CCA . >=L
STATE ZIP
IN 460'JL
LOT SUHDMSION
ON
LOCATION
ADDRESS OF CONSTRUCTION
'384n—G
4.
A. TYPE OF CONSTRUCTION
1. ❑ Single Family
2. ❑ Two Family
3. ❑ Multi -Family , },;@ to
4. g Commercial / Ira Sto
5. ❑ Farm O
6. ❑ OTHER �t ion
(Specify)
B. SEWER: Q
1. )4 Public (Name of System
2. ❑ Private (Septic Tank, etc.)
C. WATER:
I . ;K Public (Name of System )
2. ❑ Private (Well )
D. ZONING A21 0VVZ1a4Y
E. ESTIMATED COST O CONSTRUCTION
(Excluding Land Value)
s*s***swsss**sssss*sib*ss•s*s :s**�*sss*****ss*sse.
iA n►7rRov arc' " 1jSpa
❑ New Struc e❑ Addition Room
❑ Remodel,,, al Tenant
4. ❑ Foundabbn Only
5., ❑, Demohhon
t... 6. ❑ 3AccessoryBuilding
7. ❑ Swimming Pool
S. ❑ Garage Detached . Attached
G. Lot Split YES NO
Flood Zones YES NO
I. 'Sump Pump YES NO
J. ct d T ss YES _ NO
Paning Contractor
t" Plumf' g Li s #, ❑ BOCA CABO
ssssss*ssss***sus*•sits*s+rsss}*sssssssssssssssssssssss
The undersigned agrees that any construction, reconstruction, enlargement, relocation, or alteration of structure, or any change in the use of land
or structures, requested by this application will comply with, and conform to all applicable laws of the State of Indiana, and the "Zoning Ordinance
of Cannel Indiana - 1993" (Z-289) and amendments, adopted under authori of I.C. 36-7 et seq; General Assembly of the. State of Indiana, and all
Acts amendatory thereto.. I further certify that only kitchen, bath, laundry d oordrain; are connected to the sanitary sewer. I further certify
that the construction will not:be used or occupied. until a Cer6f ofcfupancy has been issued by the Department of Community
Services, Carmel, Indiana / 0I100
Si turn Owner or Authorized Agent
`J'AY PEA- LK 2?3-754a!�_ i1'01
(Print) lion Number)
Sewer CapacityAllotted T Y v
`'�—^/�'vt Inspections
dj F ting/Und4ralaboSite
Permit (Square Fo
Inspection Fees:
Certificate of Occupancy:
TO
Fee Received
Meter Base
/O
i ZOO �r
,70
x
O'er
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