HomeMy WebLinkAbout07100216 Contractor Affidavit
AFFIDAVIT
To be signed by Property Owner(s) and Newly Assigned Contractor
DATE: / a2 b °2 °O.-2 Building Permit Number: U 7100a t 6 Permit Issue Date:
Notice is hereby g ven that 'L) M 1s Luc l r is no longer the responsible party for the
Previous Contractor's Name
above-referenced project and permit number, in whose name was issued for a
' / Type of Construction
to be built at / /7 y 0 5 ' G`J ?'4 r
Address of. Construction -
As of 007 responsibility for the completion of this project will be assumed by
Date
?iDmL4D £ Po,, c-ct Co S ??' 'nJ i , 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 See, i et seq,
General Assembly of the State of Indiana, and all Acts amendatory thereto.
U r bmCA-D You Utt Corosr < 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.
Pr erty Owner(s) Signature:
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Cm ST Zip Phone Phone
. Date
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Strect Address City - ST Zip Phone Phone
STATE OF INDIANA )
SS
County of L' (? )
me, the undersigned, a Notary Public for Al.V(6-K County, State of Indiana, personally appeared
G Q ( sUvi and acknowledged the execution of the foregoing instrument this day of
?PCF.?II? 20 L !? .
Notary Pnb My Commission?ires: ?,`fir pON $ I
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U2Gl't?t CJ'I?0.IP? :aOTAgy.f
Mr eamm, Expires
(Print) 4;29!201_ -
SEE REVERSE FOR NEWLY ASSIGNED CONTRACTOR INFORMATION & SIGNATURE... _ +565022
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Contractor's Name (Assuming responsibility for project)
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(Name of Company) - -
((Signz a of epresentative or Age )
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(Print)
Y5 M. QEr-J5y(?A-rR
Address of Company
(.?/ 7? qaS - 7997 3U/ a5? 7?9a
Phone - FAX
STATE OF INDIANA . )
JJ SS
County of /1/ 0.d( UK
Before me, the undersigned, a Notary Public for County, State of Indiana, personally
appeared 'pt-f-, (I lJ?/ t yt 4 and arknowledged the execution of the foregoing instrument
l
this /n day of%<e,rk1? t 120
Noteszrry P brit
i' Jy? , f
(Print)
Rev. Oct. 2003
S:Pcmti31Affidavit9/Nc- Builder Affidavit
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TgTB OF 1N0\P??
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. /,? -6 - a oo
Date
L1c. CPM700136
My Commission Expires:
?.?US 3n-$06-Y67`1
Can,
24 Hours St. Lic. # CP19700136
Service
WEIITINGER
PLUMBING INC.
New Installation • Remodeling • Service Repair
Drain Cleaning • Water Conditioning
KEITH WHITINGER Phone (317) 794-7219
President Fax (317) 764-2624
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