HomeMy WebLinkAbout06110051 Affidavit
AFFIDA VIT
To be signed by Property Owner(s) and Newly Assigned Contractor
DATE: 1)1(, /O~
, I
Building Peimit Number: tJ 6 J / () O.Y I
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Permit Issue Date:
/I)/o/;;ec{,
Notice is hereby given that
1
C is no longer the responsible party for the
Previous Contractor' Name /;} _"_,, ,
above-referenced project and permit number, in whos ame was issued for aieJ'L'> (fC,,? ^--,
/ / ~ ~./ /J, , /J All {/ Type of Construction i
to be.built at 19.1] ~'(-1a . M/ [MffYlI ~~~J r'ttD33 , I
. ddress of Construc'tion )
As of Ii '/ , responsibility for the completion ofthis project will be assumed by
\
, who hereby certifies by. this Affidavit that any remaining building
17.. 'J
I/C~
ew 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,
General Assembly of the State of Indiana, and all Acts amendatory thereto. .
'-I..AAJ~ ,#[104/1.) certifies that the construction will not be used or occupied until a Certificate of
New Contracto
Occupancy (C/O) has been issued by the Department of Community Services, Carmel, Indiana.
Property Owner(s) Signature:
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City ST Zip Phone
Date
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Phone
(Name)
(Print)
Date
Street Address
ST
Zip Phone
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City
Phone
STATE OF INDIANA )
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County ok~ ,,, ch- )
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Before me, the undersigned, a Notary Public for 20;;7., ,(>67-' County, State of Indiana, personally appeared
/~'.,. C:. j/,-A!~ and ac~owledged the execution of the foregoing instrument this / ,6,/aCday of
') !/u-0", (..c,- . ,20 {' b. .
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Notary Public
My Commission Expires:
Yf/'/l/C D ,<,a Ac.
_ (Print)
SEE REVERSE FOR NEWLY ASSIGNED CONTRACTOR INFORMATION & SIGNATURE...
Contractor's Name (Assuming responsibility for project)
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(Name of Company)
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Date
(SiZ"~~ J:presenB.ve or Al:7-/~ ~
(Print)
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Zip Phone
City
ST
~ 01(( lS8s
( )
FAX
t
Email Address
STATE OF INDIANA )
II, J SS
County of!!/lIfIt! /;.."1 )
Before me, the undersigned, a Notary Public for ':,~-u-/{~ti;- County, State of Indiana, personally
appeared~:-:.;.:::~e 7<<&-l~;'7 " and acknowledged the execution of the foregoing instrument
this /1>/dayof-)Z&-_'-"7~~- , 20 Ob.
C7:;~ u,vtlt. -
Notary Public
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(Print)
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My Commission Expires:
Rev. Oct. 2003
S:Permits/AffidavitslNew Builder Affidavit