HomeMy WebLinkAbout05080272 Contractor Affidavit (2)AFFIDAVIT
To be signed by Property Owner(s) and Newly Assigned Contractor
DATE: Building Permit Number. S2? Z' Permit Issue Date:?-
Notice is hereby given that is no longer the responsible party for the
Previous Contractor's Name }'?, J ,j i-{-i odl
above-referenced project and permit number, in whose name was issued fora S (?? t1 / 1 G{-lC +
- /107 / - Type of Construction
to be built at 1 /l? kyRe7Z_ z
Address of Construction
As of F/C/b, responsibility for the completion of this project will be assumed by
- Date
J2W S A- W who 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 Carmel/Clay Township - 1980, adopted under the authority of Acts of 1979, Public Law 178 Sec. 1 et seq,
,G?Jeneral Assembly of the State of Indiana, and all Acts amendatory thereto.
/?J/2, /,S,oo /L,L/C>L•t/t?E7L'?-?LIn,.C 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.
Property Owner(s) nature:
7-0
(Print) Date -
(Name)
ii 01 -7z7--L92
Sweet Address City ST Zip. Phone Phone
Date
street Address City ST Zip Phone Phone
STATE OF INDIANA )
I SS
County of ? tI.i >^ )
? t
Before me, the undersigned, a Notary Public for Li(tW County, State of Indiana, personally appeared
6Ai4, 1?Si i rl+?i and acknowledged the execution of the foregoing instrument this v day of
12001
Notary Public My Commission E pees:
(Print)
SEE REVERSE FOR NEWLY ASSIGNED CONTRACTOR INFORMATION & SIGNATURE... ..............
Contractor's Name (Assuming responsibility for project)
-AL Lis
(Name of C<
/
(Signature
or
(Print)
1)445. e (
Address of Companv
6.
owuw
Phone
( ?bt? ) Lgd- 3( 1`t )"pSd Q1pQ9 Ckr--KanhICGtol,colt.
Phone FAX -Bmail Address
-`'0.6 i S W I fVI E act, f.gA/,,
STATE OF INDIANA .)
SS
County of f!tWicks )
Before me, the undersigned, a Notary Public for
County, State of Indiana, personally
appeared I- 1 L? and acknowledged the execution of the foregoing instrument
this day of \?IQ4 69 f= 20 01
Notary Public
?ab i i l^Iln -' I- a to ?n
(Print)
9G-67?
Date
t-? I'ldr it(?S
My Commission Expires:
Rev. Oct 2003
S:Pertnits/Affidavits Wm Builder Affidavit