HomeMy WebLinkAbout05030216 Misc.
AFFIDA VIT
To be signed by Property Owner(s) and Newly Assigned Contractor
DATE:
'1//'l!Of:;
. ,
Building Permit Number: (5036)/0
Permit Issue Date: -rj;f /os
.
Notice is hereby given that ~ ?/2J I-/" j, -e-H-
Previous Contractor's Name
above-referenced project and permit number, in whose name was issued for a
to be built at J'ff7J Jf-eA.f{~.eIJ 0-1- :CrD-f1/'5uill-e. -;rrJ '-iMn
Address of Construction
As of q / {'is /0 (" , responsibility for the completion of this project will be assumed by 'I'
l'D~1
---;;;?tCJlkv f( tfJ?/2d~/ , who hereby certifies by this Affidavit that any remaining building
/New Contrac~r's Name I
inspections will b~peff~~ed and that the project will comply with, and conform to the Building Codes and Zonin~
Ordi~ances ofCa~~lICI~y Township - 1980, adopted under the authority of Acts of 1979, Public Law 178 Sec. 1 et seq,
General Assembly ofthe.State of Indiana, and all Acts amendatory thereto.
-----;;;:;/-Iv-/ ---p cd;f-l2cf! CY-1-J certifies that the construction will not be used or occupied until a Certificate of
~ew' Contractor~ .' ' .
Occupancy (C/O) has been issued by the Department of Community Services, Carmel, rD.diana.
is no longer the responsible party for the
I
';jl!:{.unbtff HtVJ<) 4
Type of Construction
~iJ$':d-
(Name)
3'"1"/:; II-aHA (,d d C(--
Street Address
. r6tJ77
Zip Phone
fl/&'lh
t Dati I
.;71.Jr/JJj09
Phone
i3",/U", u; II-e
City
(30 ),
(Name)
(Print)
." Date
( )
Street Address
City
ST
Zip Phone
Phone
STATE OF INDIANA
County of Hath,'; hrz
)
ss
)
Before me, the undersigned, a Notary Public for
y; rnoN1Y 1> Wt{yd low
&pfe!-n ber
~d
l-I.:Ami (OY]
County, State of Indiana, personally appeared
/R+idaY of
I
and acknowledged the execution of the foregoing instrument this
,20~.
CONTRACTOR INFORMATION & SIGNATURE...
Contractor's Name (Assuming responsibility for project)
'1/;t'hh
Datel /
---;;-'nwflr 7 LUIlf2cfI@-<.{/
(Print)
'1 '872- ikl1-/-A~JJ {!f-
Street Address of Company
-z'-rO/l!5 V; II -(
City
y-J
ST
no 77
Zip Phone
( ;; (7 ) 7 Ti - ?LfCJ;;'
Phone
( )
FAX
t{/ 4f2.cI! a.o.J c... e.vtd/Jrr\! k., ;J.d----
Email Address
STATE OF INDIANA )
SS
County of Ha "" :1ft, n )
Before me, the undersigned, a Notary Public for Ham; toY) County, State of Iridiaria;personally
appeared 77rn o-f-lJX P W/lrdIDLJ and acknowledged the execution of the foregoing instrument
this {fHt dayof &,h.lv.hey,20~.
(;'K.IJ:-J A (/I!'dd.'JfJlY)
Notary Pu ic .
.:14' {} 7~;;d.(r
(prmt)
Rev. Oct. 2003 "-.
S:Permits/Affid~~iiSlNe~ !3uilder Affidavit