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SITE-WORK DATE ID/SIG.COMMENTS OWNEi'UILDFI DEI,CARATION
<br />I i.Ety lfrrh unr.r Fndry of Fpry fic I m crcq,l fmm llE ('odrdo6 l -icnc ti* for rlr folk*ing Et{,n lS( n}.1 l J
<br />Burircss fin Pofcsi(,n Cnd.): Ant ( hy or counry *hich r.qut.r . IE.mi rD .'ndtud. 1116. !n{'mv.. dcmhh or r.I{n 3.y
<br />nfu1m, prir h nr Nllm.. lle Eaurci rlf q'altur titr suh Frnrr ro lih. riSri {d.ftnr ihd lE or ih. s lintd ,8lur
<br />lo lh. F,viriont ol rlE Conr@ld r Li..ned Llw (Cn$l.r 9, Conlftmini wirh sc.ti,,n ?fiI) ol Divnion I orrh. Bu.in.( ind
<br />Pn'lcsi.n\ Cod., o. rh.r,E d rrE 6.rcn$ rlEElrom.rn rlr hrn ftn rL !lk!.d crcnrxhn Any rDhrirn of Sdb. ?oJ I I hr."v
<br />{ptlicllll ntr a D.mir rubj.ck lhc 0rpli.snl ro ucililPcnlxyolnor mmlhun fiv. hundrcdd.lh.{ ll!0o)
<br />-t.s\
<br />osncr frhcpmFdy.ormy.nl otr.rf,ilhwas.lt\rh.ts,lucon\kn\ tn.wrll&rh.worludrtf{t1Nnnn
<br />i tdLrl (,oilRd tu qt ISc 7l !,{. llu sixi\ r.d }li,f61xtn\(iic llE CDdrrlor'r t-...8 br{tE.ft .arltr.uo$ftrof
<br />lhcnn'Itny wh tri[,\ or ri'owr rhdn,tr {tl wk' &B rk_h H)* hurclf h.hc lr or rhmuSh his ot h., or. .mplole(.
<br />phvrLd rh.t .u(h mrmEr s n rn ddrl.t orolYcrtrl f{tr ek lll htrss. rh. tlilrul! or htm\trd i\ <'U *.hu 'n r{
<br />.f d)nrbt,n. rtE otrkr Burllq *ill hlvc rlt t!d.n of F,vnE rtui hc .r \tr drl r t!'lll or itrlx]E rri pnrFny (tr!t P!qn{.f
<br />l r u.trrfl undcr S(li,n-.1! & l'( lorlhi\'.rv,n
<br />Drr. (hn.r
<br />]rQB[,r:85]rAUtASAlltlliDlilllt8 Ix)N
<br />I h.r.h) Jllnn unJcr p.'ulrrof Fruo (k o, rh. i'l['su,3 (E(lnrri,n\
<br />-l
<br />h.E !n *rll nrlddn . Cd if.rrc of coM.r k, s.lf.ln<ur. ror wnls cE .neri'.. r. FotiLi in t y 5(r i,i l7m of rh.
<br />trhtr c(xlc. for rlE ,r.rlormrcc of th. *ork fd whih rh. Fm[ n nsu.n
<br />-l
<br />hir.ofrl willr.r'nrtrid *orkcrs .orilrnsrri( rn\umn... r! rcquirrlhrsNri lTlx) .1 th. lih, (ixl. for rh. Iirrornur.orMy*dts mn{Ensbn in\urd..ria ,n Fnay numts e
<br />81rq,,,,t, *,,,,*, 1/.* rt3Llll-1-L
<br />-l
<br />ctnily rhr in rltFrro.NNof ilE wort for whahrht Ftni n n d, I shlll mr .ry ,y $y IcNn in rny nuftr
<br />$ r! ro tEoft rut .rr ro llE Er"t6 on!.nerioi Lsi orcdifomn, lnd qE rhtrl itl \tnuld bcror $brtr t,llE
<br />sorkr\'\,nnD( rtri' I)n 'lrr( rri. l.lull l! 1h\ rh!,r,lply qth lh)r prtrisin,!
<br />I. lid rhrll sul'Fr .n ot'l]Fr ro dtmfll FflltF rd
<br />ci\il ljm\ up l on. hufrk d rho!\rtr(l dolllN lSl(x).rxxri i.
<br />Sdrrr .11)76 ol llE Lrlff ('flIc. dld .rd dtrmy.. fe.
<br />/D-at-lg
<br />I hcNhynlllr uMcr Fn.[yripcrlryrhlrI s li..n{n undd nn)vi\n,n ol ( hlnrfl 9 ldn ftR in8 w h S.cr i.n Tlrnr nr oi! triln I
<br />.f rlE Un\imr\ ,.d lhf6\k, (ii€. ,rl ny ltc.t i! m aull nnN Trl tnd
<br />a"",*"r*, B,",]e1*t/-
<br />I h.r.l,y lrrn undcr Fdliy ot Frrrry rh{ rrEr. ir . snrMbn Lidin! .lrtuy nr rlE F.rmN or llr k r 6r rtrh ihi Fni ir
<br />issucdlsec. !re7,Ci! C )knLirNrm
<br />-
<br />ASrLIIANI.U:CI.A8AI$i
<br />I hotl'y lrm lrtr Fnrhy{rFrFryoE oll,E folh'r'in3 dNlurrirnt
<br />Dcnxrlirhn Pcirrilr-ArlE\lo! Norificllun Fol.rdl RrBuhrkrnr ( rirt,{r. PIn6)
<br />-R.qur.n
<br />lltlcr of a*rfrdim
<br />I (nrly rhar rh. l.dcr.l rcE!larrn\ r8arlin!tr.'l m i!r.'t)f l{rli1. r) rhtr pn)r!r
<br />I cdify rh4 I tEn oJ rhN appliarr'.,rn
<br />erl Counrv lo.nld uF,tr rlIndiMr.\ lnd Srdrc la$.Eldri4b l,ild
<br />rti,w mn[,*{ tmFd, for i.rtEdnn
<br />Applh.nl nr.\Arnl SkMluF -,,/o^!/^/q
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathino
<br />Shear Wall
<br />Framino lD 2-6 -/6 0?tf4 I
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar '/"//-/g-//24 lz/t',l,/
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif
<br />FINAL /z- tt- /t 't J)ct'l{aa
<br />Certiticate ol Occupancy
<br />Notes, Remarks, Etc.
<br />BUILDING. INSPECTOR RECOBD
<br />Set Backs
<br />UFER Ground
<br />-l.
<br />B o$rcr.f rlE FrIEny. d .i.hriv.ly.ont*rin8 w{h lk.n€rl .onrral(^ r, ('nrd rh. lroFl ( S< ?olt Bulls
<br />srn hoft\si,n C.xr. TIE C0ntEttr\ l,i..n* l-r d.r\ rt spply b !n or n.r of Pn'Fny sh' t u,ld! or inll)owi th€,s.-
<br />!tr'i *tn dnrlncll lnr r!.h txrFh wnh i Or dtonnltctrcd,)u ui n, rh.(j,nr&1oi3 t-f,..t Lr*,
<br />t rxLi( Add.6!:
<br />f-------T------
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