HomeMy WebLinkAbout05100072-AffidavitCity of Carmel
DEPARTMENT OF COMMUNITY SERVICES
AFFIDAVIT
Building Permit
To be signed by Contractor
Notice is hereby given lhat--~~--~n'~°r's Nm 'w'.~ __ is no longer the
( ': , ' c)
responsible part)' for tile above-referenced project in whose name building permit # cvs: ~'~ 7 2
issued for a to be built at r/~ 5~~ 2o O .
(Type of Construction) (Address)
As of_~__., responsibility for ~hc coxnpletion of tiffs prqjcct is being assumed by
(Date)
others.
Contractor s Name
(Prin0
(Doing Business As)
(Date)
Contractor's Address and Telephone Number:
STATE OF INDIANA )
N,, ss
County of ~
Bcforc mc, tile undcrsigmcd, a Notary Public for cc~ ~ 0,% County, State ol Indiana,
personally appeared __~ 6/~&aC and acknowledged
thc c~cc.ufion of the lbrcgoing instrument this ~_~_~--* day of ~__, 20~-
Notary Public My Commission Ex~{(e~OMMiS$ION EXP.
ONE CiViC SQUARE '
CARMEL, INk IANA 46032 317/571-2417
S :Permits/A ffi davits/Bldrgone
No~a~ Publl~-
SEE REVERSE FOR 1,q~WI,,Y ASSIGNED CONTRACTOR II~FO .RMATION & ~IGNA~u'RE, .. $~ m/b~d/ana
My Commleaiml l~pllll. Nov. 15, 2009
11/17/2005 14:15 9176843468
NOV-I?'.2OO~ OZ:Z4~ ;RO~-
AMERIMAR
PAGE 83/03
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