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SITE.WORK DATE ID/SIG.COMMENTS OWNEI BUILD'R DET]CAf, NON
<br />I hd.try !,tun uodd Fony ol p.9ury rhd I m .rorti tun rh. Co Ecl6 L(68 L.* fot lh! lollowi.a ,Er. (**.703 L5
<br />tluins d kofdion Cod.) Any City or Colnly whGh i.qut6 i Fnir to .oddd, .l(s, improve &nol6h or (Fi my
<br />.lrudue Fnr b ir! i!ru!G. .L!. .ctuiB th. +pli.sr for $ch Fhil lo iL. eisn d rtilcGl thi lt or rlE i! licaad Fm&
<br />ro rlE FrvtioB of rll Contrrdi Liccn .! Lr* (Chrprq 9. Cotllttldine *nh Sdbn ?000 ot Dnnion I of th. aBnEs .rd
<br />Pmf6ioN Cod.) r rh.r lE d Jr n .ro!f, thd.tor !d th. bG. for rh. dLB.d daFr. An' rbiroo olSGIio. r0l I t by uy
<br />,pglird lor . Fni lubJ6r! th. +plicer lo . ciril FMhy o f mr mrc lho liv. hu&.d &rlhB (1500)
<br />-1.
<br />s omr oarh. FoFdr. or ny dplo)6 *ilh vrg6 a th.n vnc comDdsaion. "ill d. rh. * t ad th. sld@ a fr'l
<br />idarlj mofrdld foi sLlsa 704t. &Bins Dd ftnf*bB Co& Ti.Co r.ld!tkrut wtIBslq'9lyloe.eFof
<br />rtE Fl?dry [lr t!!lld i'4.tr!6th-a an *b dEshwli t|llvlrorlE*lr rMtqi ha d ls oq alplortq
<br />Fo!& rlrd sh nFDEEr' &d ilaa.d or.llmi ft, -L lt ho$q. r b|ld4 q iEFsiEr 6ild *rhh m )a
<br />oforplai'tr rlt ()9n6 B{ilds riU h!\r tlE hrd6 orFDri4 rhr lt tr .n< drd ,n hild d mF!* tlE FoFry ftt llE Frpr of
<br />-1.
<br />s o*E orrh. rroFry. d dctun ty.odr..1n{ s$ h.6a.d.otueoR ro.oMtu.lllE FoF {Ss 7044. &Bi,6
<br />.,n PDlsii cod.: Tt. co' r.doa! Lkcc Lr* &16 mr 4ply ro x o*c of Foltnt sho hlild! o. inFoE 1h66..
<br />.!d sho olrrErt fs uh FoFs *nhr Condro(3) lid!.d F,.ld torh. Conr.dd'. Ltqe lel
<br />I am.rmpl undd Sdion-.ll &PC f(lhsi6on
<br />l).r. i,.n.r
<br />!r ol.(] lL!' ( (rr\t Pr \sa-oN
<br />PESJAAIAT
<br />lhd.h) alfirm unds lEan\ orF)uD on.ollhc r{,1k,*r8 ddl,Iiron\
<br />I h!!. !d will Einrain ! C.nifrdc oaconhr lo SdlJ6u. ror mrk.n' omp.nrlion, N Fovid.d for by sdlio. l! 70o o f fi.
<br />kru Code f@ rh. FfolM. of llr wrt for *tkh llE Fnit i isu.d.
<br />I h.\. &d f,ill m.inhitr *dt(. cooFelio. ,N,ft.- s r.quned b, kbn 17m of rn L.b.i (ild.. lor llr Fr(lle. of
<br />llE trorl for $hrh lhn Fmn ir iedt My *st NnFNrio. ilMoccffi6 !d Flky numba..
<br />Polk) Nmbq
<br />-trpc
<br />$.-,ry rrr, . ,r," p.r"M. or th. eorl ror *htn rhL Fnn ir is!c4 I rhlll mr dnplo) oy F&n o my mEE
<br />$ Blobcom!!bjd!orh.s 6'conF!.riJr bs of Celifoh'., ,rd lec $, ial lhould h6om luuct lo th.
<br />mrl6' comFs.lion prcvnioN olsclion l?00 otllt t bor Cod( I dElL fonh*irh ..npl, wiln lfioE PdvilioB.
<br />wARNtltC: Frilc ro gc NrL6' NEpqEd$. 6ra4. i! uLwtut. ..d $rll {bitr 6 dpbF lo sinind Frris a
<br />.iv fic up ro or hqi.d thourad tbll4 {tlm.ooo), in .Jahion to llE @r or codF6aio.. drirad a Fovd.d ror lh.
<br />i,.*rcd4{9*1,*,,,"*,, Hi,"t'
<br />| | ( FNsifi coN rlAc'mR
<br />TECIAAADA!
<br />t ha$r .rlm u!rd6 port' of Fruy rnr I e liE!.d uldd Foris. of CIEFE 9 toffiiry *nh Selbn Im) of Dn'iri.n l
<br />ol th. BuiB xd Prla@bB Co&. id hy lioE ii in tull foN nd drcl
<br />t)X"*"n,.-lq7 tzq
<br />Y-,.lebiat{),-,,^*,tg.- ll"i",.
<br />caljllat,lcualLl.l;dDlllilc[!(}
<br />I h@by afirm uhdd rEralty ot psjury thd rhnc i! . coGrto.lioo hdinS .{nc, lor th. Ftorfucc otlh. s.rt aor *hich rhn lrnh it
<br />'su.n(S< 1@7. Cr C )
<br />AIII,I(ANI-IICIASAIIA!
<br />I hady alftn unrla rE lry oa p6jn oE ot $. fallo*in! dalr..r.tu
<br />lbmlni,n Pmire^rh6los Norilicdhn Fcdall RqlLrbE(Ink 40. P.n6)
<br />R.qur.d l-drd of Ndifrdhn
<br />-l
<br />cdiry rhd th. roldal r.sulrtbB i.8idi.g .rldor llmlJ E ml +pli{:bk lo lhi! p(F.l
<br />KZ7.-,t ,r'. r r'o.,oa,u.pplr.hn d d!. rhr 0E storc htonnrD. 6.drdr l.ec io 6npry r nh d cry.d ( omr!
<br />oi{ile6 od srd. l-N ElrrB ro boildins coldru(iotr rn hs.b? .dnoria ,!t sIr ir6 of tht Cny &d Couly lo orq l4ot dE
<br />,'li,r. tr'Lnr'nnc-l plin nr f.r '6l<jgX ru,r(6
<br />X,pr(.nr o.
<br />^sd,
<br />srrn.rur ",/l----
<br />p^u* ^",*n. r(ot t . !a1a1,P to/zt/t{
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lns u lation/Energ y
<br />Drywall
<br />Ext./lnt. Lath
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report Y
<br />Flood Zone Certif
<br />\,^
<br />FINAL I I Lt lltr
<br />Certificate of Occupancy , r,rI -=
<br />Notes, Remarks, Etc
<br />BUILTJING. INSPECTOR RECORD
<br />l-6J.i!Ad&s:
<br />Subf loorNenVlnsulation
<br />Brown Coal
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