HomeMy WebLinkAbout0003.91 Contractor AffidavitAFFIDAVIT
DEPARTMENT OF COMMUNITY DEVELOPMENT
1 Civic Square
Carmel, IN 46032
DATE:
FROM:
This is to Certifythat the IA6 a7 1Ay16 for lot %' of
�! (Inspection)
TGy� subdivision, permit number S -9� has been completed and done
according to all applicable parts of the following: One & Two Family Dwelling Code, The National Electric and/or the
National Energy Code and/or The Uniform Plumbing Codes and the Uniform Mechanical Code, all as amended. I certify
that I am executing this document for myself or that I have the authority from the entity I represent to sign rt, and that this
document shall bind that entity and all further reference to "I" herein shall be considered to refer to such entity.
I further certify that I have executed this document in order that I may complete this project without further delay,
In further consideration of the City's acceptance of this document in lieu of inspection, I agree to assume and accept any
and all liability for said project and will hold the City of Carmel, its employees and agents, the Department of Community
Development and the Building Inspector, harmless from any and all liability to arry person or entity for the failure to make
such inspection and I further agree that I will pay the City for any and all expense, including attorney's fees, resulting in
any way from the llaacckofofsaid inspection or items not inspected.
DATE: �/ / c� n -HI o
(Signature of plicant)
(Print
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STATE OF INDIANA )
es
County of = gllaWc OJ )
BefQ�[eym�e, the unndersig , a Notary Public for County, State of Indiana, personally appeared
and acknowledged the execution of the foregoing instrument this day of
�04 sin 19 91 .
My Commission Expires:
MAwON COUNTY
COMMleM otv. MAIL 21.1iM
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