HomeMy WebLinkAbout1315.98 Contractor Affidavit n���r�
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AFFIDAVIT
llATE: _j���� 13uilding Pennit Number: �� �� �b
Issued: ���y P
To be signed by Cm�tractor and ]'ropert}' Owner
i�otice is hereby given that�� ,I,[S�� �0 ����s�no longer the responsible p�irty for the
PreciouY Conlrac�ur's�'an�c li Qj
abo��e-refercnced pmject in wl�ose namebuilding permit # 1,3�.' was issued for a 2�S} �(1 ���L�
p � 7}•pc of Construction
to bc built at Ic�:� �� �L.D'�iyl .Ek?a1Cf�
Address
As oC � ,���� , responsibilit�� for the complction of ihis prujcci �vill bc assim�ed by
o��� �]�
�Q�'j� ���/`(1�'1 1 , who hereby certifics by ihis Affidavit thal any remaiuin� building
Nc�v Conlraictor'e Namc
inspections will be perComied and that the project ���ill comply with, and conConn to ihe I3uilding Codcs and
Zoning Ordinances of Carme]/Clay Township — 19SQ adopted imder the authority of Acts of 7979, Public� Law�
17S Sec. 1 et scq, Cei�eral Assembly of the State of Indiana, and all Acts ainendatory thereto.
�,��`� ��fn°� ) certifies that the construction ���ill i�ot be used or occupicd until a Ce�rtificate of
Nc��Convactur
Occupancy (C/O) has i;ecn issucd by �he Depart�nent of Community Services, Carmel, ]ndiana.
Property O��°ner(s') SignaYure: �
��1,p �-��/Vn.a� � � �� g`!
(Name) Date
_��,�- ���l rvl e-�
(Print)
(Namc) (Datc)
(Print) �J
Propert�� O�cner(s') Current Address �C Telephone #: � / � ����
1�Syy Sc-�'��s�, �
(Co be Notarized...sec next page)
�zl�Jnc-11� tY�v✓� u����k
ONECIVIC SQUARE CAIZMEL, INDIANA 46032 317/571-2400 �� �gj �� VUC''J��' hQ�—
cl�o,n9r�' 14�rq i�� kf�ztr�
-t� d o s�?)
S'1'A7'E OP INDIANA )
� SS
County of �:�;�2,�L'�J
Before me, the ti�ndersigned, a I�'otary Public fo��22GG�Lc�� County, Statc of Indiana, personally
appeared l�'iv, ;�-� �.Q .,� �� aud acknowledgcd the execution of the foregoing instrnmcnt
,
this ��� . day of � -�� , 19 � .
�-7 ��� / �l� `�/�vcf2/C �. �� � �l!�/ — �����
�
Notarv Public Print �
A4�- Commission Expires:
:.. ... ............................................ ............................... ....�
ContracYor's Name (Assu�ning responsibilit�� for project)
(Print)
(Doing 73usiness As)
(Datej
Contr�ctor's Address & Telephone Number:
S7'ATI; O�INDIANA )
SS -
County of )
13eforc mc, the imdersigned, a Notary Public for County, State of Indiana, personally
appcared ai�d �eknowledged the execution of the foregoing instrument
this day of , 19
Notary Public Print
My Commission Expires:
Rer.Julv 1999
s: permits\F3uilder Affida�it