HomeMy WebLinkAboutPermit #19070059AP HDAV T
To be signed by Properly Owner(s) and NewlyAsslgned Conlraclor
DATE: n01M 111 BuildingPermitNumber; IRb7005`f Permit Issue Date: 08107 iq
Notice is hereby given that ValMc M (VmeiZ�ererM— f0icson"olonger the responsible party for the
Prer,oin Coutrxcwhose name
Name COVYtyterNd � V\44IClr lZeM2J.�-F�
above -referenced project -and permit number, in whose name was issued fora IN 1=-eY v t
tobebuiltat 1405 QeXtVI�✓ \4-yla 'type of Construction
Address of Conslructlon
As of 00 f 68' I R , responsibility for the completion of this project was/will be assumed by
bate
Lob?�g( C0ntlh u & orb who hereby certifies by this Affidavit that any remaining building
New Contractor'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.
�O �ONdC IOYI certifies that the construction will not be used or occupied until a Certificate of
Now Contractor
Occupancy (C/O) has been issued by the Department of Community Services, Carmel, Indiana,
Property Owners) Stgnature:
Due
(Name) (Print) Date
101 WcS A&A1.i1 a,�{ Trdlarppaf is TA yb us ($1 }) 26l . 633
Street Address a Ciry ST Zip Phone Phone
-Au" M,( 1 8 1119
t�
(Name) (Print) Dete
NOTARYPUBUC-SEAL
STATE Or< 1TIDIANA ) STATE OF INDIANA
o n SS COMMISSION NUMBER 7066E2
County of MariMY COMMISSION EXPIRES OCT.00T19, 2�,
Before met, the undersigned, a Notary Public for CYI YI(.k County, State ofTndiana, personally appeared
( n and acknowledged the execution of the foregoing instrument this _J __ day of
20 I
ow. u1edaLhbw l°I, ao2�S
Notary Public My
Commission Expires;
WOE 1. Met ktin,
(Print)
SEE REVERSE FOR NEWLY ASSIGNED CONTRACTOR INFORMATION &SIGNATURE,,.
Contractor's Name (Assmning responsibillty for project)
sc� 3a a- N 3ov c 7 , as -soon fit , r 3 Gcpas�,,.,m,,% p�.
Phone FAX Hmail Address
STATE OT XNDIANA )
SS
County of )M(JvI )
Before me, the undersign /c /ed, a Notary Public for A ! County, State of Indiana, personally
appeared fit✓ k J ' and acknowledged the execution of the foregoing instrument
this IL day of 14 J� 201
otary Public 141y Commlulon Expires:
(Print)
Ray. OcL 2001
S:Permits/Af<davits/New Builder Affidavit