HomeMy WebLinkAbout03070225 Contractor AffidavitAFFIDAVIT
To be signed by Property Owner(s) and Newly Assigned Contractor
DATE: Building Permit Number: ~ Permit Issue Date:~
Notice is hereby given that __ is no longer the responsible party for the
Previofls Contractor's Name
above-referenced project and pennit number, in whose name was issued for a
to be built at ; cfi ~.-~. /' i x/~dof Construction
AS of ._,~_ff.~--~ % , responsibility for the completton of this project will be assumed by
, who hereby certifies by this Affidavit that any remaining building
11 comply with, and conform to the Building Codes and Zoning
Ordinances of carmevClay Township - 1980, adopted under the authority of Acts of 1979. Public Law 178 Sec. 1 et seq,
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
O cc~pancy (C/O) has been issued by the Department of Community Services, Carmel, Indiana.
(Print) Da~c
Strccl Address ~ ~2~ Phone
(Print) Date
C .ty ST Zip Phone Phone
STATE OF INDIANA )
· SS
f
County o )
Before me.
2ounty, State of Indiana, personally, a~ared
and acknowledged the execution ofthe foregoing instrument this ~'Say of
SIGNATURE...
f of Mr.
~ of permits
~'~ TOTRL. PRGE,03 ~
respof~bility for project)
ST Zip Phone
STATE OF INDIANA )
~/ ,~. SS
County of,~
B~for¢ m¢~th~ Undcrsigngd, a _Notary P.u.bl.i~. fo County, State of Indiana, p~rsonally
~pp~d b - ~ ~, ~ a~ow~d~.~ ~x~outio~ o~ ~o~goi~g ~m~
~-----~om~ission Exptre~:
Rev, Oct. 2003
S:Permfts/Affidavits/New Builder Affidavit