HomeMy WebLinkAbout05110021 Contractor AffidavitFROM : COMMERCIAL PERMIT SERVICES FAX NO. Nov. 0/9 7 {l:44 2
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NoV 16 2ClC? ; .
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..AFFIDAVIT `
4nrn. ?,-+? BY o e signed by Property Owner(s) and Newly Ass:.r,,;d Contrudor '
DATE: ! 1 1 Ao Building Permit Number: 0'5,/00--)J Permit Issue Date:
Notice is hereby given that IA fed ?AS?+uct is no longer the responsible parry for the
Prw1ous Contractor's Nam .' I ?ddi"L ?''?/>?}tlh???-J
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above,-referenced project and permit number, in whose name was issue d for Ye a Tr
ii ?r t 4ltr(oc?e retC coon
aC ?Vi eb/eMLS 6-Y c1e- _ cP. C7 pl-czq e.
to be built at /j-
Addrnt al Coosmrnetbn V
As of C I I c7 responsibility for the completion of this project will be assumed by
Date
H Yti' ? t-n ?'rneitr , who hereby certifies by this Affidavit that any remaining budding
Nev, Contractor's Name
inspections will be performed and that the project will comply with, and conform to the Building Codes and Zoning
Ordinances of Carmellclay 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.
I llsrn) rnt certifies that the construction will not be used or occupied until a Certificate of .
New Centratwr .. .
Occupancy (GO) has been issued by the Department of Commity Services, Carmel, Indiana.
Proper?tyjOwner(s) Signature:
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Cm ST 71p Pemt Phone
STATE OF INDIANA )
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County of }%lt,1iQW )
Public for d t1- ? -County, State of Indiana, personally appeared
Before me, the undersigned, a Notary*
N IMII l
and acknowledged the execution of the foregoing instrument this ?1F day of
.
2007
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(Print)
SEE REVERSE FOR NEWLY ASSIGNED CONTRACTOR INFORMATION & SIGNATURE...
FROM : COMMERCIAL PERMIT SERVICES FAX NO. Nov. 09 2007,04:46PM P
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Contractor's Name (Assuming responsibility for project)
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(Name o(Compon
,XSigtuture of Representative or Agent) Date
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Sheet Address of Company Qty ST Z.p Phone
?i '??x'1331 31 h7b?I?fi`f- ?'icY..,t?bu?I?b?.)rim;?-kx?.c?m
Phone FAX Htui! Addrem
STATE OF DMIANA .)
SS
County of f fPml
Before m the undersigned, a NotaryPublic for m @ i) Cn County, State of Indiana, personally - Pe
appeared T G'tJ , }4ir4 ` and aclmowledged the execution of the foregoing instrument
this day of 20 e ate. Gt
Pub I My roaartdsdon 6apher.
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I ll f NOV 16 2007