HomeMy WebLinkAbout18100129 AffidavitAFFIDAVIT
To be signed by Property Owner(s) and Newly Assigned Contractor
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DATE: -��- Building Permit Number: �b I C) 1 Permit Issue Date:
Notice is hereby given that r ��;{ 4 is no longer the responsible party for the
Previous Contracibr's Name
above -referenced project and permit number, in whose name was issued for a Otto 9.,
OS -
to be built at oZ� Ly (s psi 41 N
II (/ Address of Construction
As of responsibility for the completion of this project was/will be assumed by
�� /faty q
L/Weill- KltGlg.r (aaf tcW �pT who hereby certifies by this Affidavit that any remaining building
Ne ontractor's Name
inspections will be performed and that the project will comply with, and conform to, the Building Codes and Zoning
Ordinances of Carmel/Clay Township - 1980, adopted under the authority of Acts of 1979, Public Law 178 Sec. 1 et seq,
General Assembly of the State of Indiana, and all Acts amendatory thereto.
certifies that the construction will not be used or occupied until a Certificate of
New Contractor
Occupancy (C/O) has been issued by the Department of Community Services, Carmel, Indiana.
Property Owner(s) Signature:
V' �N 11 AMfV lu �lY � �LIV eSS
Address
City
(Name) _ (Print)
Street Address City ST
STATE OF INDIANA )
SS
Countyof q do )
Zip Phone
I I-iY--
Date
Phone
Date
Phone
Before me, the undersigned, a Notary Public for Ii M1116N County, State of Indiana, personally appeared
4MU and acknowledged the execution of the foregoing instrument this IF'* day of
L 1 'e,
Notary Public My Commission Expires:
IJ i oft a IQ 5 t< M f,4 (Q✓ s NICHOLAS F. MISHLER
(Print) sEnt. Countyof Res: Hamilton
SEE REVERSE FOR NEWLY ASSIGNED CONTRACTOR INFORMATION & S I1lY Comm. Eglires 02-27-2019
Contractor's Name (Assuming responsibility for project)
Representative or Agent)
WWIS
Date
hone FAX Email Address - ,
STATE OF INDIANA )
SS
County of; sue// - Cvj
Before me, the undersigned, a Notary Public for 04f^ County, State of Indiana, personally
appeared dLyGF /�oorE J and acknowledged the execution of the foregoing instrument
this rt( day of 1)5ZV�&Age- 20
Notary Public mIy Commission Expires:
Rev. Oct. 2003
S:Permits/Affidavits/New Builder Affidavit
1`pYIP"'
P •'•Gee% Notary
BRIAN D. TURLEY
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Public, State of Indiana
=;SEAL^°
Morgan County
* •, +;
Commission g 709334
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My Commission Expires
° "n°
January 16, 2026