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BUILDING- INSPECTOR RECORD SITE-WORK DATE ID/SIG.OWNER BUILDER DIJL('AR TION I hs.hr rlrm undd Frty of Fjury lhr I & B.nF trm lh. (i'ndr(s LEde l.w for llE followlg ,@. (Sa r0! I 5 Bu'n6 ad Prof*Fn Co&), Ary Cny or Courn, $th r.qu6 i Fmi to oldrud. a. i!4ro!e .kmlirt ot rt}.n m! e!.ne Fu ro ir. i!.le., .L ,.qui6 dr epra&r fo, e.h Fnn b iL. r(ncd n.orEr tli l: or CE . ncd!.<l F!!nr ro rt FouilioE oldE Coddn r LE rB.d L.$ (Chl,ls 9. Conlllrdtr8 snh s.dhn 1000 ot Dirnrn I of rh. tlNin* sd Prcf6ioN Co&) or lh.l lt d JE i! d.n9r lhg.6on !d lh. hdi! for rlE.lLt.d ddF ion Any lilbri,n of Sdbn 70r I 5 b .ny rrplicer fo, . Fnh uqal. rlI rrplkd b ! civil FMn, olml mrc llu lirc huhrh.d doll6 (1500) l.6orffiofih.lnrFnt.ormvmplo)6$nh\.*6sth.Es'kcomp.E nn. *ill & rrk $ct oid 'lE slulu. ir ft{ id6r,cd or o ft6.d fu slc (S( 71}r.1. Iluine dd korBsB cd]. I h. (inttdr ! l.i.as t q d{6 nor tpply h a o$ n6 ol rh. FbFry $ho htril&.. imrror6 !tso( and whodc skh so,l hm!.lfor fisrclfor rhhwh his orhd oqn.npbyN, providcd rh.r uch mprovffirr ft frr inrarld.l or oftaal lor $L ll tk)$6.. rtE hlitliq or inFovddr is eLl *ihin o.. )w of compldion. lhc O*nd ltriis ull havc thc hrdd ofFo\ins lht h. or sh. did tun bdkl or inFllt lhc Fopdy aor rh. Fl,Iak ol' l. 6 o*E otrhc rnFr), M a.luiEly.o bdrg $nh Lc.nr.d..ir6oE to Llldrucl 'lE Fnj..t (S. 7o&. l}lEms r.d PrDftsbd co& Tt. ( onrrtor3l-icd. hw &,6 ml !!rly kr & o*nd !f FoFn, rho b{ildr 6r inpro\d IhGrn, md vho ontrxlr ftr u.h Fj.tr! qnh r Con{do(3),rd!.d prlsd r. rh. (ndra:roar Licoe t trJ I m.rmIi undq sdrn .a &P(-forihErqrn !o8ri!85.:ca!4ENSArlA! DECI.AI^IIO! I hs.b lmm!i&r pdriy olp6jrton .f th. follo*b8 d.d.r{ioc I hav. !d trill roi.rdn i (.nifi.d.olco.sr lo s.ll lsurc n" ( 0116' lrnD.nsd nrn. d Fovid.ll for bysGtn'i:r7(r) ofrh. Ljbor aode lor lhc p6fomu.. o t lhc w.rl ror {tich lh. Fsnir u au.d Ihav.a.dwillmaimdinworlssconrEnslltu.insuranc.,dr.{ur.rihysdk,nlTto.lthctnborCod..forrhcPsromrnccol rh. sort for *hichlnsp<'nil B i$!.d. My *uk6 coEFEalion rBudr.c rnid anJFlicynom&t rc .l c.n'b dur 'n thc Ffoirllm. olilE *o.t ad shkhfin Fnn 6 Bodl.l lll.ll ml olpb! uy F&n i!..y mF $ d to bdom subd ro lh. $!lt6 onFaEnn. LE or Cdrtomia ud .*rd lhd if I irbuB heom ub€l lo llE w 6 moF ionFo!!$Bof Sclbn lrmolllE L.bor Co<k l JdL i,nh*nn @mpl! *hh rlrE FovilioB wAR !\G: Fnts lo Bq. $$t6 6{Fud6n ordlc 6 unL$tu|. lrl 3tdl lbF 6 orphyd $ (mEl FhhB .,xl civil n.6 up ro oc hundr.d rhos*l d.ll6 (ilm.mo). in.ddnon ro lh. cox ol comp.iE rio( daEs6 a Fo\il€d for rlE &.rion 1076ofrn ubor (odq intEd lrl ibrEy's f6 Appllonl:__ ucl:lsEL(QlraAqraa llEctaSaf.la! I heb, ailm uid6 FElly of rsjury lhd I on lica$.d und6 rroviii..l( h.prd 9 (comnm.i.! *ilh Sdtion 70fi,)!llrtnn,n ll of rhcBai.*ed PmfdirN Cod.,. mylic.M ir in tull forc srj.lld caNsrBglltatrllBDl!0-alil!(I I hdlby lJIm usr6 Fuhy of Frjury rhn th6. ! , @dtu(ion ldldirts +*, fff llE Ffo,Mc of rh. *!rI lor $'hah rh! tEni a i$u.d {56.l0)7, Civ C.) artuc6tl.Dligdt4ua! I holtr !trm !ntl6 p.nlll y of FJ!r) otrc .f llE fouowiq dc lelxong Danohion Pmirr-Arb6tG Noriltrln,n F.dcr.l RcsuLtioN ('I nE 40. Pd6) R.quio] ldrd of Ndifrdbn I csrit rhn rh( fclsll ,.srldsc E*a{'ns 6b6ros r.mr.l {. Rn q''iral& t' rhi! p.or..i ..,5 t44 rurr$r!.r.Fdddn6.f t ,omrbrnh.[ Cnt r.d ( oulr :hir Ciry &d Cour, to drs uFn rlE Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Subf loor/VenVlnsulation Roof Sheathing Shear Wall Framing ln s u lation/E nerg y Drylvall Ext./lnt. Lath Brown Coat Itilasonry Pool Fence T-Bar Handicap Req. Deputy Final Report Engineer Final Report Flood Zone Certif 'l-r7- tt 'J)zblz t 'e/ Certificate of Occupancy Notes, Remarks, Etc COMMENTS ***{,(h, I I I I FINAL