HomeMy WebLinkAbout07020089 Contractor AffidavitAFFIDAVIT
To be signed by Property Owner(s) and Newly Assigned Contractor
1
DATE: // ? Building Permit Nu?imber: 0??d Permit Issue Date: Notice is hereby given that S?? ?n/1 f//UC7)D? is no longer the responsible party for the
Previous Contractor's Name /a Ot
above-referenced project and permit number, in whose name was issued fora Type of Construction
to be built at J; ?! ^ SI ?Ym??, ,04una
Address of Construction
As of /0 % responsibility for the completion of this project will be assumed by
ez J- zh!i^?, fgmra ? who hereby certifies by this Affidavit that any remaining building
norm at
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,
General Assembly of the State of Indiana, and all Acts amendatory thereto.
11011ef /1U %'4 d-14f44y? rn 1 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
r?
nt) / Date
)q5 Fff2t
Phone
(Name)
Street Address
STATE OF INDIANA )
SS
County of )
the
Date
City ST Zip Phone Phone
a Notary Public for County, State of Indiana, personally ap ared
and acknowledged the execution of the foregoing instrument this 1 day of
20 4
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77 Nottaary Public My Commission Expires:
(Priat)
SEE RE-VERSE FOR NEWLY ASSIGNED CONTRACTOR INFORMATION & SIGNATURE...
Contractor's Name (Assuming responsibility for project)
of Representative or Agent)
(print)
/////z/ /?
Date
a-) c? L) ya5 ?iis
STATE OF INDUNA )
SS
County of
ST
Fn it Address
Before me, the undersigned, a Notary Public for! County, State of Indiana, personally
z /
appeared ? z?4 e ??-e fl and acknowledged the execution of the foregoing instrument
this 44 day of ??r s? -Fv> 20 O
Notary Public My Commission Expirm:
(Print)
Rev. Oct 200?
ST , -:s/Affida%iMN'eu Builder Affidavit