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BUILDING. INSPECTOR RECORD SITE-WORK COMMENTS OWNER BUILDER DI:I,('ARATION I hft4 .lrtrn undd Frlry or rElury rh.l I d cr.mpr fron rh. (tir&roB l-i.aE lrs for (fi. L[o*n3 ,.e (s6']oll 5 Busin6r Md Prolsio, Codc) Any ( ily or Couni, uhich r.qun6 . Fnn to coNlrud. !llq. imI,ovc ddnolnh or qE', iny nrudue prF to iri i3sudc.. !b. kqun6 rh. ryllicd fo.3uch Fmil lo frlc a sisn.d JIlddl thd h..r dr n licc.d Pomanl to !h. proririB of llE Conltrlo.! l-icos.d tir (cr'.prq 9. Coimd.inB \nh s<i.. 7000 of Di\ri'. r .l rn B6'nd tnd PntsirE ( o&) or lhn lE ( thc ii dd.p( rhdcftom !r, rh. hs6 lor 'lE .llq.d dmplhn A.i. \nL'Fn of Sdion 70!l ! h! !.t .prltul ,or i Frnd 3ubjds rh. {rlicer ro r.'ril n hr of nor frrc ths lirc hund(d .rollm (l5m} l. s owns ol th. ForEny. o ny dnplor6 *nh *is6 al rh.it $1. ..mpc6ation. rvrll do lh. s orl En rh. iidE k nur 'nro(kl orofiq.d fo, elc (sd ?0.14. BGi.B ed Pr.ldioB ( od. I fi. ('onLsclo.s l.icds lrs do6 nor .Ptly ro m ornd or rh. Irlrd, * lb tlikl G irrror6 rh6@( and stF &E sh *!* himr.lr.r helf or rtmush hls or hq oqn drlq d. Fo\ it d rh.r Mft unpro\€d! r. mr iddi.d n.rir.d tur laL la. krtr-d, th. hl dr* or mrFor.r1d it $ll *rhr oG \d or @trpLri\ rtE ( xG &,1d, $ rll lEr. tn. hnh or FnirB rlu h. or tE dil ft'l hild or E!ft! lh. Fqd\ nn llE FIFE of l. sorns orlhc p.opdry. an.[lusi!.ly .onlhdint *nh li.n..n r.nlraclotslo coml'u.r ltE Fojrl (S( 7044.ltusins a,-l Pmftarir ( od. rh.conren,! I iccnr lis do6Nlaa,rll. lo !io*ndoarm!.ny sho build,or rmprordlhdtun, &d sh. m dr! lor s*h Foj.rt $ nh . (-onrBlo(s, liccN.n poGutn r.$.Codrdors Lk.M lr$, I m.rmti undd sdnJn D.l. Oincr \!oF(r Rs' ( o[lPllNsATloN D[Clr.B81I{l! I h-rl'! .mm undd FMlit of Fjln oR of rh. rolh$ iq &(hrr io6 I hlr c u'd q 'll mhlrD ! Cdl'ftd. of congr !o s.lf-IHr. for !0116 mnpslrdNn. B Fr idcd for b) sdion :r 7(n o r lh. litrr Cod.. for lh. FfnMcc of rh. *od loruhichrh.Fdil6 itudl I h,v. rnd wrll m.inrlir *orld conFcation iNtrrrm., 6 r.qrn.! qq S<1io. I7fl1 olrh. hbo. Cod.. for lh. psforunc. or rhr *.rI fm uhih rhL Fmn i! ($.d My *ortd rcmtEGdion iMru. cffi id Flq nunb.r r. /* it, th Il^5vrqrre Cu^tu..] (.,,^.'...* BApK booo Sqo''t t t 4/ttt1 <.diryrhd i. th. Froffi. orlh. s'ort for shth tht Fmil Lr Bu.d, I stdl.or dPhy.ny Fsn in.ny dMnd $ 610 h.oft lbrar ro rh *nlld snpad.n l$! ofc.iif.6ia &d .sc thd ir| lhuld tEoe ebF ro rh. sort6' @rq6!.t i,. Fsriii.rB oa sdion l70o .a rh. t hd Coda I ndl, tnlll*nh Nflrry wnh rh6. Fnr irhB IIARIING F ihE b su. $orl*' snFsri.n srdas. i urh*tu|, .id lhdl subF D aphF l.' ofrind Furi:,I linB up to on. fiur&d rto@d dolld (rloo.om), in rddirn'. ro rh. coi olcomr'.Nlion, ddtus- B pro\id.d lM 'n.tion 1076 ofrh.ljhor Codc, inrd6r od dronEy s 16 5/t1/ t1 I /t1"ul'l !!lx.!D-ul](la! Dt:( l.\t,\t(rt I hmby irnn und6 p.n hy o f p.rjur) rhn t 6 I'.o(rl und- ForB$n ol (-h.I,rd e lcommcins {ilh s.d ion 7m0) of t)lriFn 1 of rh. BNi.* .nd Pmasionr ( odc. en my li.o!. n in aull ror& dl .rdr (5r,lIo \oLo -]l 5qA; rVut Orayt c vwr+.f (.ONS'TRU('TION LENI)INC ACIiNCV I @ .rm !nd6 p.n ny or p.rju,) lhr lhs.6 r codru.rion t dss +trt for th. FaomNc ofrh. tuk tu $nich rni! Fmil i! Bsu.d (S< (n7.(ir C) I .nd! ! \D. ATTII(ANLDESJSAIIO! I hdlb ard un&r F xr of Ftur- .R or th. folh$ in8 d.(L,.! hN Dcmhion PmngArbdor Nor'6oisn F.ddrl R.guh6tu (rdk 10, Pd6) R.qut.d t.cr!d orNotifi .ltnrn I c6liryrha h. fcddrlr.suhrioB Egrdin* s&s(r rmor al d. n.r 4'r,licabk lo lhs$i.d I.diryrhdIh.r.radlhir.tl''lErlhn!drdcrndlh.otn\cinfonD.tx)n6.otrdI.*Rroonpl!rnhtll(n)..d(oun'l o.disR6 md srd. Ir*s Eldru l. biUins colgrucrr( rd ioltD rdlr,m. EF6dd tr 6 ol rfiG Cn t !d ( ounrr r. 6rd ulrn rh. y czt+ S/tl /t7 Set Backs Forms/Steel/Holdowns Erection Pads SLAB Floor Subf loor/VenVl nsulation Roof Sheathing Shear Wall Framing Drywall Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req \ Deputy Final Report Engineer Final Report Flood Zone Certif FINAL I i-/{-/4 J rJ.9 ,t4fr?)) Certificate of Occupancy Notes, Remarks, Etc. \ t DATE I ID/SIG. I UFER Ground I lnsulation/Energy I I