HomeMy WebLinkAbout05070067-AffidavitDATE:
Notice
4ssigned Contractor
Permit Issue Date:~
is no longer the responsible party for the
for a
Type of Construction
Construction
;ibility for ~he completion of this project will be assumed by
and conform to the Building Codes and Zoning
s of 1979, Public Law 178 Sec. 1 et seq,
tot be used or occupied until a Certificate of
Services, Cannel, Indiana.
Phone
(Name) ~t~
.County, State of Indiana, personally ap. peered
the execution of the foregoing instrument this ~ day of
SEE REVERSE FOR NEWLY ASSIGNED CONTRACTOR INFORMATION & SIGNATURE...
Contractor's Name (Assuming responsibility for projecO
(Print)
Emafl Address
Gounty, State of ~k~d/arra: personally
~x¢¢ution o£ thc forcgoin~ instrument
Rev, Oct. 2003
S:PennitsdAfSdavits/New Bu//der A~idavit
UBLIC
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