HomeMy WebLinkAbout0005.91 Contractor AffidavitAFFIDAVIT
DEPARTMENT OF COMMUNITY DEVELOPMENT
1 Civic Square
Carmel, IN 46032
DATE:8 G f I g q
FROM:g05¢�IL �• pyS
This is to certify that the *612"HE 1+-(SPtvt1v for let— -of--
b �` I t.(Inspection)
104- 3uwigfP i � ."-subdmsim, permit number A r7 — °A I 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 it, 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 any person or entity for the faiture to make
such inspection and I further agree that I will pay the City for any and a x ense, including attorney's fees, resulting in
any way from the lack of said inspection or items notjnspecte4 /'—�
' .W!RKIM�Oh
STATE OF INDIANA )
SS
County of CAr�or� )
Before me, the undersigned, a Notary Public for (Mar�6n County, State of Indiana, personally appeared
a. ,,,,, c and acknowledged the execution of the foregoing instrument this Co" day of
11&N y-j , 19 ct, .
My Commission Expires:
Notary Public
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