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BUILDING- INSPECTOR RECORD SITE-WORK DATE ID/SIG.COMMENTS OWNI'R A!ILDER D1:L('ARA loN I hdcby a,tuD und6 p.n nt oa pdjury rh.t I d dcripr lrun lic ( oil,lcroR Licnk l,* Lr rh. nnl(N ins rqr,tr ts<.ro ! l .J -BBin6s ud Proldion Cod.) Any Cny or Counry *hrh r.qutrd r Im'r lo con.rnri- !lrd- trnn(tr.. J.rnolFh or E!6n ry irudr.. Fb ro {! Nu cc. lLo,cqutr6 rh..rplrur ro, ru; p6mi r, fil.r r'*n.n {domr ihd h. rh?. ?mid F,-.c lo $. proltioN of llE Coni*to.! Lico3.d Llw (Chq,r6 9. Comh.mi.s s irh Salnrn ?UOO of Dn 'rnn ! o t rh. lrulh6t r l PFf6ion! Cod.) or lhsl h. d dE n .rmpl rfi@from od rh. b.$ aor th. rll.s.i .ronrrn'n A.y \ iolllnrn of s(li,n 7011 5 hy !n/ applicmi fo. r Fmn 3ubjdl! th. .lplic.nl ro ! cir il ,.mlly oa mr mor. rhM fi!. h!nd,.n dolln ( 1500) _1, a osE of rh. FDpdry, or mt mplorG wih *as6 6 th.n sE smFa.lDn. *ill(h tlE solt rrl rlr {ru1uc ! ni.tdt d or o,Is.d for sk (Sa.7044. BsilB od Pr.l 6G Co<k Th. Co.rrror! l-i.e l.* d6 @r qrlt tu o o*G of lh. IloFty who hrilA r iflFDâ‚¬ iE6( dn \ lb &E ut *!n hilMlf or rE*lf or rtFust hi or hs o\ r ophr 6. FoviLd rld i@h imFovdGn. @ Dr indd.d or olE d n xl. la, lstrgc. rlE b{illins m lrp.oloE i i etl sih'n.ft Jd oaconpliia tlE o!*E Brilda will lIw llE h!d6 of FwA rt lE or !& dn mi tlild or in!.or! lh. FFq t'r dE pclrE of I. a o*E of rh. FFry, m dclciv.ly.oirxrins *'irh liccB.d co ffroE ro mBrud rll proj.( (S< ,L!r]. hB,lr .,rd hDlsir Cod.: Th. Co' rxroi! Li.a* Llw &'6 mr {rl, to d o$F olFop6ry sho bril& or inprovd rh.6..ud who odrart ao. 3(h FojE.l! *irh r Co rxro(r) ltou.d p{Mr ro rh. Codrdm r Lkm L.$ | I a .rdF undd Sdbi_ ____ Oid: \aoR(FRS ( (rlttPtNslltoN DES.dAAIIAB I hd.t y dlrm undq FEly of Fju! oR of rh. follo*inr d..l&.rn6 I h.vc rd $ ill Bi.lrid . Cdifrn. of Co@n ro s.lf.l6e tq *sio' .ohFt6ann. d FoviLd lor by S.n ni r 7(r,r of rh. t bq Coda fo.l,E Ff(xlff.of rlE srt &.trhah lL Fnn i isocd _lh.Eadf,ill i .ir rort6 comFMio. iera.- 6 rEquuqj tD Sation l'700 of rh. lrhor Co&- for th. Froll1e. ot d! *st for rhkh lhit p6hn ir iErd Mt *.rtd- omtEiiFn i6uft..16 ,i polry tunls E 5 +--. z â‚¬.., *D I'te"*y*-*-_!45$,!S) f ,,on lll z t -l cdit tld in ilE Ffor],E. of th. sorl fd trhich thn Fnn ir isc.( I tull mr @,'hyi) F$n r xr nuE$ a to t@m sbrd lo E ssria' omFlaion Le! of CdilomE .d Cd thd 't I rlilld tE(oft $lr.fl to trEw*6' 6rpaE ion Fnlirbd ofs..tion 1700 of rh. I iDr Cod.. I ltEll. fdth{ irh o'npl} s nh rh.- ForlirB wARNINC FljluE lo sw *!n6' omFsio. s\.is. it u.h*tu1. r.d tull sbrd e frplo\r to (miM, F6iB r'd civil fin6 up lo orc hurd lhound dollh {ttm.ooo), o rddnirn lo rrr cot .f conllrd.riln. &ds6 r! t'nldnt hr tlt sdnr. 1076 .f lh. Labor Co&. inrqd DEOJAAIIO! I hothy dlm uda Flhy ot Fiury llld I o liâ‚¬E d undd Fir irion of(llT'ra s (mnmtrin8 $ith Sdhn Uxr) orIhi.ion I ol rh. B6ilB ed PrcfdhN Co.!., &d my ltN t i. frll lor.. nn.her 6 .73 oz5 a"r"('rl rln I I calsrallf,llDl,lluNilc!:!(I I hehy arm Mdi FuIy oa pdjury lhn lh@ i, r .oElru.lb. lcndins !s*y tor llE FqfoflMc. of lhc sorl ror lhirh ltis Fhn i! isucd (Sd 3097. Civ C). APIUCAIfTIICLAAAUO! I hsdy arhn undd po.hy olpdjury on. ofrh.lollosinr dclardion3: D.molnion Pmir3 A!h6ro! Norificarion F.dnal R.sullrnrns ( I il..l0, P0n6) R.q!t n kll6 ol NotifK.lnrn I cslily thr lhc f.ddolEgulalioN E8Eding sb.stor r.rho\dla. nor amli.ahl. ro rhb tnrjsr I cGlill rhar I ha\.rd{tth*ion a'd 3lot.lhd rn.ah!. inldndion n.otrd lrsrb$ndy ordin.nc6 rnd Star. Irrs cldi.s honzcqr.stlln6of rhir ( iry aho\. Mrio..d prepcny fot ud ( .u , ,/610 uNn fi. drlrr Set Backs Forms/Steel/Holdowns UFER Ground SLAB Floor SubfloorNenUl nsulation Roof Sheathi ng Shear Wall Framing tl Ext./lnt. Lath Brown Coat Pool Fence T-Bar Handicap Req Deputy Final Report Engineer Final Report Flood Zone Certif I FINAL 7/k'lavz'$futlrla ns Certificate of Occupancy / Ereclion Pads lnsulation/Eneroy Masonry Notes, Remarks, Etc.