HomeMy WebLinkAbout05090188-Signed DemoTO BE
Enforcemenl
NOTE:
Demo uirements
City of Carmel / Clay Township
Building & Code Enforcement; City of Carmel
IN 46032 Ph. (317) 571-2444 Fax (317) 571-2499
ed by the appropriate
and fuel
)vernment entities, or
~ility of the
Jch approvals.
Well must be plugged according to Well Ordinance A-62.
must be pumped and removed from building and/or property.
Tax Map Parcel #
nclude that information,)
of
THIS PAGE) when you submit your application package.
ations, City of Carmel;
FAX (3f7) 776.8506.
S:Permits\Dernolition permit handout I of 2
09/2612085 13:19
F~o~;
3175712265
C~RMEL LITILITIES P~GE 82/82
0~122/2005 0~:~6 #252 ?.OO~
CERTIFICATE OF AUTHORITY
Under the penalties of perjury (Indiana Code 35.44-2,1), I hereby affirm, under oath, that all of the
Information I have provided in this application for demolition permit Is trna and accurate, to the
best of my knowledg~ and belief, and that I have not knowingly or Intentionally provided or
omitted any InformaflDn that would tend ~o hide, obscure, or otherwise mislead the Department
of Community Servlc,~s regarding the truth of the matters addressed therein.
Further, I assert that ! am the property owner, or the authol'lzad and lawfully appointed agent of
the owner(s), that I have e.?mss authority and permission from the owner(s) (and anyone with a
recorded interest or ether interest in the property), I; take this requm,"ted action, and that I agree
to Indemnify and hol;~ harmless the City of Carmel from any claim, lawsuE, demand, or damages
whatsoever arising m~t of, or as a result of. this request or the actions of the Ci[y of Carmel,
regarding same.
(Name p~nflad~
Appli~ant'a Address
_,-%,
Date
City, ST Zip
'STATE OF INDIANA )
County
Before me. the uadarslg;ted, a Notary Pub[Ic f~r ' Coun
appeared, and aekn~wle~ ~e exe~on ~ the ~mgoln9