Text · page 40 of 117
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witb nu applicable codes, laws1 and regulations. The undersigned hereby certifies that all of the
information contained In this llpplication Is conect and true.
Owner Name: ti 1~HA~t... Cot.EE. .. . Email: .· mc..o l-E'f 15'~ (i) t;;,4-14 '~"Co&(_
(Applicant or Co111/LLC must co111plete the affidavit on the next page to sign as the ownefs agent)
Owner Signature:~ _8{!,,_______ DaUl: 1,.'2 .J (.('1 '2.tJ"2,jq
!fJ)WIS"&R OF PROPERTY JS Acos,01tATION, FILL IN LOlfER SE~TIOrf.
TO SIGN AS AGENT FOR PROPERTY OWNER:
IN .ACCORDANCE WITH THE TOWN OF AURORA BUILDING CODE ORDINANCE (SECTION 65-8 B.2)
I, _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ___,.
ST ATE THE PROPOSED WORK IS AUTHORIZED BY THE PROPERTY OWNER AND I AM
AUTHORIZED TO MAKE SUCH APPLICATION FOR A BUILDING PERMIT.
(Signature of Applicant)
STATE OF _ _ _ _ _ _ __
COUNTY OF_ _ _ _ _ __
TOWN _ _ _ _ _ _ _ __
Sworn to before me this _ _ day of _ _ _ _ _ 20_ Notary Seal
(Signature of Notary)
----------------------------~-----
IF PROPERTY OWNER IS A CORPORATION, COMPLETE:
STATE OF NEW YORK
COUNTY OF ERIE ss
-------.-----:-::---:---::-- being duly sworn deposes and says t.hat he is the applicant
(Name of individual signing application)
above named. He is the _ _ _ _ _ _ _ _ _ _ _ _ _ _ _of said owner or owner5; and
(Corporate Officer, etc.)
is duly authorfaed t.o perform or have performed the said work and to make and file th.is appUcatlon: that
all statements conta.tned in this application are true to the best of his knowledge and belief, and that the
work will be performed In the manner set forth in the application and in the plans and speciflcationtt filed
therewith.
(Signature of Applicant)
Sworn to before me this_ day af _ _ _ _ _ 20_ N<Jtary Seal