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SITE.WORK DATE ID/SIG.COMMENTS (}WNER BU IT,DF:R DEI,CARATI('N
<br />I ncrchy rifinn utrdcr pcnalrr o, t rjury lh,r I d,n.rcn'fl,n,n rhc conti.t'F l-iccn\.l-r* tar rhc n,lhwin8 rciv,r (Scc 7).i15
<br />Bllncs anJ Prntsi,)n C(rlc) Any Cily or Counry eh(h rcqu(c! d Fmir k! c.n{rucr. alr.r, ihtiov., d.mlah dr tolltr rft
<br />ntu!tuc. tritrb irr i!\uh-.c. llso rcquires rhc ipplicant lnr such!.rnrrl. lllc. ngnci n.t.'mnt rharh..r shc is lrcn$d lu^unr
<br />n) Ihc nn)visn)ns .r rhc Conr&r,'s L$n\.d l-rw lchrlrlcr l), Coomcncins w h Sccrnrn 7(X)0 ol tlivisinn .r oI rhc Bu\im$ .rrl
<br />Itol!$i,,ns CoJc) rthlrtEorshc i\ e\cnfl lhcrclidnuJ rh. has\ turrhcallclc,t crcn ion Anyltr,rionors.crkr70115brany
<br />al)|)hcx lnr rltnnir \uhj.rrr rhc sppli.trtrlb a.ivilncnrllyol nolnr)rclh!tr hvc hurrdlcdd.lltrs (S5lX)).
<br />-l
<br />3\ owtr.!oirhc F'pcn y. ,r nry. n[lo]c.\ wirh wr*c\asrhc \)1.co rF.. \a(trnr. s,UJo rh. w(k drhrdnktrtrc'\nor
<br />r[.,xt\.Jororl.rc,lrnrsalc(scc7(r,14.I]Ntrrsm,lP,ollsonsc.(rcrlhc(i!ri.ntst.,.cnsclj*Joc\ror,mlybrn.wDcrol
<br />rlRln)Ii y wl'o h'ldr o nr{h}c\ th.K)n. rnJ wt$ (ltE {'.h *\nd hrnr.ll or hc^.ll or r hntrsh hr or h.r own cmttryc.!.
<br />l)r,vi'l.J rh{r $ch mrln.vcnEnh{chr intc cd .r.llir{ lnr \.lc Il, l$*cv.r. rhc hrild'tr! or n\}ovcmnr s nnd qirhir .trc ycr
<br />ol.uukrnrn, rEn ()pn.r Bur.lcr w l hrvc rlr bur,lcn oi provr8 rlur Ir or \h. Jkl n builitorinDn,v. thc nn)p.ny lbr rhc lrurl-r ol
<br />_1. r\ owmr ol rlrc !r)pd y. unr c \el[ ivc ly .onrnd ns wn h l'(ht.d coi(knn r) (,nnfur rhc tr('j.( r (s.. 7lll4, Brln(s
<br />r tlrrt$!.nCoJcr Th. Coil'rcrr'1 l-(ci\. t-rw {lor! mrrt,dy ro aD o*nc' ol nnncny w[o hurUs or i,noovc\ rhcrcon,
<br />xnJ *ho roorr&clnr chpr(+chwnhr((r mLrtr I n lr.n..d tll^tr n ['rh.Conkr.rtr \ l-kn{ Ij*r
<br />-I
<br />am cr.npl undcr Seur a & PC.la, rhs r.n!r.
<br />IVOR|(Ei'ScOnllEn_SATloN
<br />!EC! BlglQ!Ih.NhyrlnrDtrn crpcn ry.l ll.rjry orc ot lhc hll()wurr d(ld{ i,r\l
<br />_lhalcunuillmlmrain0CcnilEarcot(l'.scnrloSclrlnsurclarwortF'..nlP.trsdn,NJhrvi]cdforhySerurITLDdrrhc
<br />hlltr C{{e. li)r lhc pedomakr ol lhc w.rk l which rlrc p.rnn s isnkJ
<br />.- ADN CoSz'7 3 .r*--
<br />, c.n y rhrr rh.I}.r,oroBn.ol rhc work ntr *hrchrhis p.rmn s hn'$.t,I shrll or cnrl)y !", *rr,,, ," o"rnr.,n')f(, 1r r. lB-onE n'hF.r n] rhc wolkql .ompcndnr hwr ol Cal'turnh, rJ .!rcc rhrr il I sh,ru h.(,ft suhid n, rl{
<br />{orkcs (omi'.nsrlr,n tmvri}nr niSc.rkn,l7(X}ofrhc L,htr C(xlc.l llnll nflhw h connlt wrrh rh$c ln)li\iirlsII RNING| [aihrc n, Kuc $o.kcs ronrrcns,lnn ovcrulc is utrlawtul .in +rll suhjc.r an cmfkJy.r h caminil lf,nrhE\ r
<br />(iv'l ln..\ nn 1.,,n" hLnJrJ rl' u{n,l J^llrr\ Lllr}l,rY{r. 'n
<br />J,lJ ,,,n h rlr!.,.r | !rrn tr\rrr.n Jim.rrc. r\ fr.v.dsj tnr rh(
<br />.k-., -,i "tr.-/k". 1 //
<br />Dn,€, r/c/zozo #^\ .+-/'-='--7- liitiEI7ortn.rcro n
<br />t f('taL Tto\In.rl)rltrn'u (rt^-.nrlr),,1p(rlur]rhlLnl'\cn$JLt!e/[\'.ninrrahJn'.'!'!ommn.Dptr hSnrtun7mx]'rrDr,.n,n I
<br />.l r|c ltusincs anJ P(n.ssi({$Codc. mJ ny I'c.n\. i: in lllli(trcc JcllR1.
<br />?o 8t68
<br />t/e / 2620 $,1
<br />I h.ohy,lltrr unJcr Fcnihyoipcrjry rlur rhcrc is !.on(dctn,n kn(lDe.-!.trcy br rhc |rrlornrd.. ofihc work ntr wh(h rhi( Frmir i\
<br />r\ucJrse lrv)?, crv. c )
<br />APPLIC NT DACLAN-ATI(IN
<br />I lrR.b! illm urJ.r rcorlry o, Frj0r, orc or rhe tnlbwin8 lelnmrnnr:
<br />Dr.K)l iotr ,,.!nirsAshc(os Nolrlralion t;cicr!lR.!ul.ridr\ (lirlc,l0. Pan6)
<br />k.qutrcl l!t.r ol N.rii.. i,)tr
<br />_lccn'ly rhar rh. riJ.tul r.e[hrnn'\ rcgulinl rrbc{.r r.trk)v.l!r tror rt'flndhtc L) rtris pr,}i.r
<br />-l..nilyrhir
<br />I hrvc rcd rhirlptl(rlnr od (rrcrhd rh. rlx'v. i'no,'mnotr '\corcrr Irlrcck)$nflywirhrllCiryrtrJCotrnr!
<br />o'J'nrn.c\ xnJ Srarc l-rws r.hriry t, hu rcfc\cDt.nvcsofrhrC y rnd Counryn, cnrcr r$)n (h.
<br />rh)!c nrnrtrnBl pn)F,rylu irslx.l
<br />Applient or,\rrtrl si!nrlu
<br />rhr. iBI hcr.hvdtrrhrn?.
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Roof Sheathing
<br />Shear Wall /'a
<br />Framinq (7'll.'/r/o 'tblbP (w
<br />u o Ene a t'ilP2<)
<br />7.wlttu
<br />ltu*-Ptu@
<br />fj't:/lnt. Lath .)..//.4/a (Wr/tut:5& -^,'Brown Coat 7152t)o Sbrdb ,Prdr'
<br />It/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />F_[ood Zone Cgrtif . .I
<br />,\)cra,hlt (-fu(Z/ilrh Lbstult '4tt
<br />l.t A,
<br />FINAL 4%l'/{/o UWl"t,7aE 0
<br />Certiticat e of Occupancy
<br />Notes Remarks Etc.
<br />BUILDING. INSPECTOR RECORD
<br />Ihlvcinrlwillmrxrrwork.dcomren\rrn,nin{ftn.c,rs.cqrrc!t'ySc.(i.n1700.irhclih.rG)dc,lo!rhcll.nnnrncol
<br />rhc workl,trwhrhtlnsp.nn rs siu&l Myworkcis'rotr,pcf,\rri,r i'Ntrrr.{.rntr r F,licy nnmhcr rc
<br />I N V.4 5,, rc
<br />tz/r/zoZo
<br />/'6' zo zo
<br />Dnlc'---'
<br />Subf loor/VenVl nsulation
<br />Dryw-Al ry$
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