HomeMy WebLinkAbout05110158-AffidavitTo be
for a
is no longer the responsible party, for the
Type of Construction
:bat any remaining build'rog
the BuildingCodes and Zoning
- 1980, adopted under the authority of Acts of 1979, Public Law 178 Sec. 1 et seq,
all Acts amendatory thereto.
be used or occupied until a Certificate of
issued by the Department of (
t Address
Z~p Phone
Date
City ST Z~p Phone
State of Indiana, personally appeared
~__ day of
ContractOr's Name (Assuming responsibility for project)
FAX
STATE OFINDIANA )
LLL
~ssion Expires: