HomeMy WebLinkAbout05110101-ApplicationCity of Carrnel/ Clay Township Permit
c6MMERCIAL or INSTITUTIONAL IMPROVEMENT LOCATION PERM]T APPLICATION
For Commercial or Institutional: New Structures, Additions, Remodels, Tenant Finishes, & Accessory Buildings
BUILDER of
RECORD:
OWNER:
LOCATION
& PRO3ECT
INFO:
NAME PHONE
FAX
ZiP
surrE # Jif Applicable)
FAX
ZIP
of Shefl Building (If different than Address of ConstrucUon)
Lot # and Subdlvisloo (If Applicable)
~IU~ING, PRO3ECT, OR TENANT NAME:
~ ~/2/%5
DESIGN RELEASE #:
WATER UllLl~
PROVIDER:
$C01~($) OF E~
SEWER UTILITY
PROVIDER: /~
/ BZA / BPW DOCKEr NUMBERS; AND/OR
COUNTY WELL AND/OR SEPTIC PERMrr #'S (If Applicab[~):
# of Room: ~/ Elevator or U~: [~ ~
(Privately owned hosp~als
a~l medical offices/centers
are comme~al)
[] INEFfrUTIONAL
[] Municipal/Public Bldg
[] Churm
F~: (Check all which
apply for the new construction area)
~ SLAB [] CRAWL SPACE
POST & BEAN C3 BASEMENT
(or POST & PIER) WALKOUT: _Y
ZONIi'g;;
PLUM
FOOTAGE:
-' E OF I, VEMENT:
[] NEW STRUCrUIE
[] ADDITION
[] Room(s)
[] Porch
[] Mezzanine or Deck
[] REMODEL
E] NEW TENANT FINISH
[] ACCESSORY BUILDING
[] DETACHED GARAGE
[] A'FI'ACHED GARAGE
~.cELL TOWER (New)
ELL TOWER CO~LOCATE
[] DEHOL1TION
PRO = -'NFO ' - N:
Early Release Manufactured
Permit: YN Trusses: Y N
Lot Split: Y _N Sump Pump: YN
Does any par~ of the property lie within a special Flood
designation area: Y N
PL MB NT - 'OR:
Plumber's Indiana state License #:
Class I structure penmts are subject to the General Administrative Rules of the State of Indiana (See 675 IAC 12) regaxaing expiration time fxames for
begimling ~md completing construction
I, the undersigned, 3gt¢¢ that aay construction, ]mcoast~uctioe, e~lat~,~en~, relocation, o: alceratio~ o£ a s~, CCu? or ~y
requested by this application will comply with, and conform to, all apphcable laws o£ thc State o£ ~diana, and the ,Zoning Om.mance ?[ ~arm~%m.o,~ - ~, t~' --
289) and amendments, adopted under authority of I.C. 36-7 ec seq, General Assembly of the State of Indiana. and ah Acts amen~atow thereto.
~itehen. bath~ and floor dr~ns are connected ~o the sanitary sewer. I farther certify th~x the construction will not be used or occupied until a Certificate o£
)een issued by the Department of Communi~ Services, Carmel. Indian.x
Under Slab
Rough In Site
Revlewed/~pmved: Dept. of Community Services ( )
OFFTCE USE ONLY: **********************************************************************
q5 0 __
Base I.spections: __~ ~:~ ~' 7~ ~ ~a~edReviewsRe-
Cert, of Occupancy: ~ __
· ..~ ~'~/ ~' r~/.~/ Additional Fees
TO~-a-L. ~ t , ~