HomeMy WebLinkAboutAffidavit`�"���� cA ��'F
aCo ` � �`n \
'..; �
1 , O
a�
�� rroN `a�I^
AFFIDAVIT
DATE: _� � � _. Building Perrnit Number: _IG��f�o� b�� _._
(ssued: 21 ZD ci
To be signed by Newly Assigned Contractor and Property Owner
Notice is hereby given that�i�\5 �� �A� is no longer the responsible party for the
Previous Contrartor's Namc ..
above-referenced project in whose name building permit #� b was issued for a_�JW �Mcv,� 1�-,�1_
Type of Const uction
to be built at _� a,0�1 � J�nP � 1-, ,rh„ Re�
Address
As of 3- �-(— a;0at�_ , responsibility for the completion of this project will be assumed by
�1 Dace n
1 uQ_ �GV�C\ tC�O�� c�� �-��ohCawho 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 Canne!/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 t�►ereto.
��Lle'�'Y��}�F't� �Q015 0�� 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, lndiana.
Property Owner(s') Signature:
�'
�/ 'v�-- - �'__
��lame)
4/1/2020
Date
Jason C Bro�vn
(Print)
(Na�nc;)
(Dat��)
(Print)
Property Owner(s') Current Address & Telephone #: 12075 Shelborne Road, Carmel IN 46032
317.430.3494
(To be Notarized...see next page)
STATE OF INDIANA )
SS
County of �j��►1,l )
Before me, the undersigned, a Notary Public for
appeared �, (� �(� � C
_ ar
this ��� day of +�yr �� � , 20 �
�
� y�-L.�.�C7 �C_, l..v;�-%
lvoca�y Puvlic
My Commission Expires:
1� ��.�
--�___�
-------------------------------------------------------------------------------------------
Contr o's Name ssuming responsibility for project)
, � �`.; , ,�� �
`C�1 � � c.� ���-1ne ���
(Print)
4�V.�.e. � G �e� �o,o1s � � =�-+� ��.
(Doing Business As)
3 �- ��r - �oao
(Date)
Contractor's Address, Telephone #& Fax #: � ��`� �c�� n C�C�.r1�S1 �-(�C�tc�h�x ''i-��
3��t ^a��_ i�
STATE OF INDIANA )
SS
County of )�`i�� )
Before me, the undersigned, a Notary Public for
appeared 1 1 11 k.A ��.h_9•.�"�1�. ��;C"��
�ti���F County, State of Indiana, personally
and acknowledged the execution of the foregoing instrument
this � day of {a.r' � � , 20 �-�i .
ou� �C
Notary Public
My Commission Expires:
"I o'��-�o'�
*Q.e��r;i
� �> ?:ti '�.
�� .i. L-
.
, �a �� .�:
Print � ,;' -ti . �F:.4�..
-..�.. . ,,_,
. _ . ���;.
�, - _`'', _ � ';t � _
�. f ,' %,:,, � �' - �+ �_
r,. �
.,, ,,;. u
Rev. Oct:��102 � ' e = �� �• " :'
.,�-.
S:Permits/Af'fidavifsBui4�'N�;Pc�tii�iauie �
a �, y . . r.'_�_�_.,
riui� ,