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BUILDING. INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS OWNEF EUILDER DEII'AR TIOII I h(.t') llfm undd FMlry.f Fju^ rh, I m .rdnli e.n rhc (tdr&i6a 1a.e lr* ror rh. rolkNhs r@n (S< 1011 5 11616r rd Prol6irn Cod.l An) (1) or (no ! $ikh r<tun6 r Fnn ro c.dM,.116. mFo\.. &rmttn u, Er6tr rn) ntudu(F kr ni isltNq s c]trr6 rh.4{,ltut for $.h Fm roliL.si8ndndmr rhd h.or nE ir hcdEd p{md ro ih. Fr,3irE ofllE Cont*oar Lr6!.d trw (chrB6 e, c.mmd.mB {irh s&tio. 70m .f D'!irF. I ofrh. B6ins'rnd Phldiion! ( od.) or lhal h. or 3h. !.tonpl lhd.from ed ln. iErlr for rh. !ll.8aj.\mprion An! \i.LrionofSdion 70:ll.s bv rny imli.ld for a pdmir subjcrs rh. atpli.inr ro ! civil pcnohy of nor morc !h!n livc hundEd dollm I ts(x)) l. .r 0{16 oflh. FnFdy, or h, .mplorc wilh wa!6 a rn.n yn. .oiFE tion. $ill do lh. sort dd lh. sn(1@ it mr iniqtcj or.rd.d lor Flc (SE n!r4, lurilB dd ftoldiom ( dc Ih. ( r'ntdols Li.N Ir$ &6 not afi'ly ro M o"n6 of rh. rn'I6t qho tril& or inF.€ rh.6.. ,rd *h6 d.E ssh {!rI hifrrclt or hcltor lhrcu8h hit or h< otr n mplor.d. Iru\rlGl!h!rruchEFolord!e,idorldo.olIa.dtr$l.llhq6s.rlEtliuinAorfltr.!ffia$Utrnhinorc!wor(onl,hru tlE OrE B{ilr6 $ill h.\! rlE hmltr ofFornE $, h. or rtE drj d tlitl or flqn* thr Fntd) nr rlE F,F& of l. B on E of th. FDFrv. M .(lustr .[ conridi.S $nh h.c$.rl .onr d.6 ro codtud rlE F.,.d (sr 701.1, &$n6 .r*l Pn)is.in ('oj. Th. Conrrmror! I -iLosc l-as do6 nor appl) rJ M otr n6 of FoFnr. r ho hdilds or iorFr ot s r h6on. iid trho conrBds for s.h FojRt. $irh ! ( onrklodsl i'cor.d pu^u nrrh.(irnrrdras I icor I:s) l i crcn,tr unds SNli r .B &P( firrhisr.a3otr D.r. orn* woR]<f, ii(; aonrprNsartdN D.ECIJAAIIA! I hscb 8mm uida FMX) of Fj!^ ok of rh. rolbsin! d<rnlr i)6 I h.r. ri $ il I Mim.in a Cdilr.k .f ( oBar r. s.lf'l M.. l no't6' NmFsnion. 6 F.r,<Ld lor b,t S6rirn 17m of rh. hh]l co{.. lor fi. Ftull]e. of lh. troA Lr $nth llE Fhil ii is.ij I tuv. ind $ ill m.inr.in s.! 16' .onrn Bari.n ituuranc.. ar r.qun <l hl. Sdr rn I7m otrhc lrhrr (i]d.. htr rh. pdLllmc of rnc mrl tu shich lhis Fmir il irsu.tl Mt $ 0116 $dpsrFl ion iBuran.. Lnid od Flicy nuhh6 ec @L.".'.-' u lrr--r..r.q n -a-<- ,*,"* 'f63 7 7 /a7 -- \ r.r,- lcdrlrhd'nrh.FfolM.olrh.so*aor$hkhthtFniBau.d.lnEllmt.qro!mrF$.!nrrm66 F B lo B*orc tutir to lh. \!*6 conFEdhn l sof ( difonir sd.8Erhi if I rh.lld h.rod 3ubd htlr *!rrd NhFts lior Fovbi)d of .krion :u()o orrh. t td cod., r rldl, fodfi$ nh omrly $nh rh.* t !\ 6ioB. \*ARNINC Fiil6. ro s@ "rtd $nFnldbn covsls. i unLstuL 'nd 3h,!l sub.cr d dphlq k, oniMl tEBki6 snd cnil fin6 up !o on. hun&.d rh.Btvl driua (tl0o,00o). in rdd'tbn x, !h. con oa.omFuri.n, d.h.r6 a Forid.d lor rh. ssrn,n 10?6 olth. L'b.r code inr.6r dtrd dnoma.ft s !lL!|r(\rft)\ I H, lrm uld€ Fo.h! otFjo.y 'hd I e lEdl!.d uidd F$rirb. of(trFa 9lomif,8 $nh S<irn rmo) of Division I or llE Buin6 xd ProldilB co&. ii ny lie i in full aoc inlficd trc.(is /osl-s ^" a a/a {//l / ti.ffi Numlq <_ d;=<- I hqlby lmm und6 Fnah, of Fjury lh, lhs. n i conrddbf, k diie rgocy for lh. p-fom.. of lh. w fot *hkh this Fmit b Leru.d (s6 10e7. cir c) AITII(ANLDISJIAUA! I '.,9l+ afhn unds po.lq or p<rjury on. of rh.lollos'ng d.(l6dlion! D.oolltNn PmilvAsb6t.s Nolifi cal'on !-cdd!l R.Suldions ( rik {0, l'd6l R.qurcd l.dld olNotifi (alih I .d'l} rhd th. f.n$l r.gulirkrn\ rqrd'n! s\h6l.sro.\i|tr. n.r rfl,l'.ihlc b rh's rol.cr I cd'fr 'nd I ha\. red 'hi! .ftlk.rion drl j!'. rhd th. .t r.'nrr'tuhr6codd Ilgre!ommdl$ih.ll('ihlndCounh ori'nan(6 .nd Sr . L.trs ro hil,lin3 .odrudki( an hd.l,) artr'rr. r.F.drn 6 o I ihs (-i ) rd (-ou.r) !o dra urF. !h. .h\. MrFn<d FoFn) f( 'rpr ic.nr or ,1Bol skn.l tS @ tJ<zza) -" a5 /o 6/tV Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor S u bf loor/VenV ln s u la tio n Roof Sheathing Shear Wall Framin g lnsu lation/E ne rgy Drywall Ext./lnt. Lath Brown Coat Mason Pool Fence T-Bar Handica p Req De U Final Re rt Engineer Final Report Flood Zone Certif . FINAL b/ic/i1 t a r'kttt*t).rd En 9+{y"\) Certificate of Occu anc Remarks, Etc Set Backs I I I Notes, I