HomeMy WebLinkAbout05030219 Contractor AffidavitAFFIDAVIT
To be signed by Property Owner(s) and Newly Assigned Contractor
DATE: a 6 Building Permit Number: 0 b3 ?? l 1 Permit Issue Date: z1-1-,-7,00S-
General Assembly of the State of Indiana, and all Acts amendatory thereto.
certifies that the construction will not be used or occupied until a Certificate of
New Contractor
Occupancy (C/O) has een issued by the Department of Community Services, Cannel, Indiana.
Notice is hereby given that TOO'S r?? is no longer the responsible party for the
Previous Contractor's Name
above-referenced project and permit number, in whose name was issued fora
to be built at (?? ? ? ?l?1i .t1 ? t'C I?l/ j2= rl+SS ?(?(?} ?66 3 -1z e If Canstructloo
r J Address of Construction
As of responsibility for the completion of this project will be assumed by
at
?c 1 who hereby certifies by this Affidavit that any remaining building
New Cant is Name
inspections will be rformed 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,
Property Own (s) Signature:
JeA Sckc6f
(Name) (Print) J / Date
1 f ? 1 ? i AJ l? 1?G l P?SS Igm CZ OtVq ? 033 ( 317) V ?-- 0,5
Street Address City ST Zip Phone Phone
Date
_ r
Street Address City ST Zip Phone
STATE OF INDIANA )
SS
County of )
Before me, the undersigned, a Notary Public for ( County, State of Indiana, personally appeared
r, 0 A# and acknowledged the execution of the foregoing instrument this ),;,& day of
4
y Commis on Expires:
SEE REVERSE FOR NEWLY .ASSIGNED CONTRACTOR LNFORNILATION & SIGNATURE...
(Name) (Print)
Contractor's Name (Assuming responsibility for project)
(Name of Company)
25
(Sp tur of Representative or Agent) Date
STATE OF WDIANA )
'SS
County of
Before me, the undersigned, Notary Public for t ??? County, State of Indiana, personally
appeared !i Jv and acknowledged the execution of the foregoing instrument
S
i
this day of 2WL?
6 - GZ-z'?
My Commission Expires;
Rev. Oct 2W3
S:Permits!AfFda-AwNew Builder Affidavit
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