HomeMy WebLinkAbout07080125 Contractor AffidavitAFFIDAVIT
To be signed by Property Owner(s) and Newly Assigned Contractor
DA7g,; 167 Building Permit Number: ???' ()1 25 Permit Issue Date.
1,totice is hereby given that E, " e L o? ' is, no longer the responsible party for the
- Previous ContractoPs Name
above-referenced project and permit number, in whose name was issued for a t -u l -h p y-? Type of construction
to be built at 1 i)?RO<E W0 4zy) hr
Address of Construction -
As of responsibility for the completion of this project will be assumed by
Date1 P4'
Sd? who hereby certifies by this Affidavit that any remaining building
New Coatraa r9 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.
fly aL+, V? certifies that the construction will not be used or occupied until a Certificate of
New Contracmr -"
Occupancy (C/O) has been issued by the Department of Community Services, Carmel, Indiana.
I
Property Owner(s)
Sumt Address
11
STATE OF INDIANA )
SS
County of
Before
Shy rt?t J? ?> , -2652-01
(fit) Date
y?e?4 I ? `(-CcN132 (?? ?l3-??
ity ST Zip Phone Phone
(Print) - Date ..
ST
Phone
Public for ? County, State of Indiana, personally appeared
and acknowledged the execution of the foregoing instrument thisT day of
' 20 -
Notarv Public My Commission Expires:
(Print)
SEE REVERSE FOR NEWLY ASSIGNED CONTRACTOR. INFORMATION & SIGNATURE...
Contractor's Name (Assuming responsibility for project)
(;dame of Company)
(Signature of Represents or Agent)
?harn- lC?o t-•
(mint)
10
Date
), - Y v If ( ?J 4(D 032 7-
Lip
El
Phone - FAX i! AddF] ress?
STATE OF INDIANA .)
SS
County of )
Before me, the undersigned, a Notary Public for County, State of Indiana, personally
appeared and acknowledged the execution of the foregoing instrument
.
this day of 120
Notary Public My Commission &plres:
(Print)
Rev. Oct 2003
S:PermiWAffidavits/New Builder Affidavit