HomeMy WebLinkAbout05080272 Contractor Affidavit
AFFIDA VIT
To be signed by Property Owner(s) and Newly Assigned Con/roc/or
DATE:
!)/;(p/!l~
Building Permit Number:
C) S" () go 0l7;?
Permit Issue Date: cJ'j' /d1 k t.')t.')~
Notice is hereby given that ;r::.7:).c L&/IV' ,f ~.!J'e>c/A ks pJc. is no longer the responsible party for the
Previous Contractor's Name J:- A" I' A ~ '
above-referenced project and permit number, in whose name was issued for a &"IIJe.vr;7AL.. A/,tl..tl/il'/,:9#& -,<:'1 lilt' s' S '"
//07 L4tJ,eeL~,()
Asof C?6/C!J?
}late . /_
S#/e/ ~1t.')K~n
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. I et seq,
Type of Construction
to be built at
Address of Construction
, responsibility for the completion of this project was/will be assumed by
, who hereby certifies by this Affidavit that any remaining building
General Assembly of the State of Indiana, and all Acts amendatory thereto.
d%e/ ..hk
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.
(!::ewne7J~t:~ l
(Name)
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(Prmt)
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(faror
(Print)
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Date
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Zip Phone
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Phone
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Date
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Phone
STATE OF INDIANA )
SS
County of ~(j CIl){)\
Before me, the undersigned, a Notary Public for --ff\Ck\ ; r~ County, State of Indiana, personally appeared
COJO \ t{~S '-~ ~cfnowledged the execution of the foregoing instrument this 2S day of
20 0 Co.
(0 l~ o\'
My Commission Expires:
(Print)
SEE REVERSE FOR NEWLY ASSIGNED CONTRACTOR INFORMATION & SIGNATURE...
~ -..
Contractor's Name (Assuming responsibility for project)
5HIEL- S-t::l'-Tc:>...J e-O.
(~;^=nlU ~1-J
(Signaiure of Representative or Agent)
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(Print)
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[Jate I ,
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Street Address ofCo111pany
(,..JO, ,c...-J/"PO L-lS
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City
ST
Zip Phone
(3/1
Phone
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(3 t1 )
FAX
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Email Address
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STATE OF INDIANA )
SS
County o~G-'" '-O---l
Before me, the undersigned, a Notary Public for ~"-G.-"~ '--'-' County, State of Indiana, personally
appeared ~\J....'-~ ~~ "';:::",<md acknowledged the execution of the foregoing instrument
this S~'-<...J day of ~ 0 ~ ~ , 20 0(0
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My Commission Expires:
Rev. Oct. 2003
S:Permits/AflidavitslNew Builder Affidavit