HomeMy WebLinkAboutDemolition Certificate of Authority.pdfCITY OF CARMEL
Demolition Certificate of Authority
Date*
Permit Number*
Applicant's Name*
Applicant's Email*
Applicant's Phone*
Address of
Demolition
CERTIFICATE OF AUTHORITY
Under the penalties of perjury (Indiana Code 35-44-2-1), I hereby affirm, under oath, that all of the information I
have provided in this application for demolition permit is true and accurate, to the best of my knowledge and
belief, and that I have not knowingly or intentionally provided or omitted any information that would tend to hide,
obscure, or otherwise mislead the Department of Community Services regarding the truth of the matters
addressed therein.
Further, I assert that I am the property owner, or the authorized and lawfully appointed agent of the owner(s), that
I have express authority and permission from the owner(s) (and anyone with a recorded interest or other interest
in the property), to take this requested action, and that I agree to indemnify and hold harmless the City of Carmel
from any claim, lawsuit, demand, or damages whatsoever arising out of, or as a result of, this request or the
actions of the City of Carmel, regarding same.
Signature
9/8/2022
B-2022-01205
Sam Milligan
sam.milligan@northridgellc.com
3174179884
City
Carmel
State / Province / Region
IN
Postal / Zip Code
46032
Country
United States
Street Address
13065 Clay Center Rd
Address Line 2