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BUILDING. INSPECTOR RECORD SITE-WORK ID/SIG.COMMENTS OWNr.R AUILDER DE[-CARATION I hd.tt rllm und.r Frn) oa Fjury rlu I m .rdnl{ 6om rh. cotutrlm l.td* lis for rlE lolh*ins 16. (S< 70! l , &!Uld rn Pr.f6bn Cod.) A$ C ).r C.udt trhkh r.quG r Fni ro c.,\{to{i..lro. mFo\e rkml& or rw! !.'! nMEq Frnro ns isllaE. &o r.qur6 rn +?lter fd ruch Fni ro 6hr lrsad nn.l6t tr lE6. !h. i lkqed puorr b rlE Fo\nh6 ol rlE c6drdo.s Li..N.d t " ((tuF6 9, comtrir8 unh Sdio. 7i)00 of D'rnD, I olilE Bdi,6 t.d PrladioN ( o&) or rhd lE m JE it .rdF rhd.from dd rlE t-it for llE .Uenl 6ol9|(n Any \ hLrion oas€lion 701 I 5 b nt rfil'o lor {ciir rubjdG tlj. rrpli.ur to ..iril p.eh] of mt eE thh liv. hun&d {hUr6 (1500) l.aiosnsofrh.Fo[i6ly,ormt.mplo)6* h$aX6f,rrhor*n.comFneion.$nldrrtu*ot{ lh.nnd@bmr i.radal o.ofid.n LrsL(sd70a4. BlsinRrdnd ltof*n,N ( od. 1nG Conlrrkr'r I icoE l{* &6 nor aqtl, lo an .\rF of lhcrlrEly sho hi!.hor impmv6 thdon. Md srk\ &!6 uch BrrI himr.li or h6rl r or 'hrourh hn or hd o$ n cmploy6, !rcv id.i th strch inFivoMt & mt i add o olI6.d ntr eL lf. howd6. lh. tlildint or im[ro!.lBl t snd *ithin on. td orcompLlior ltE(nv6 BuiEs Billhlr.lh. hrdo orF$rn! d!{ l. or ih. dit mr hrild or n{ror. rh. tn,Flt for lh. Ert soa I. e o*G.tllE Fopdry. B d.lcn.b codrdh$ $nh lk.tri.d .onlr&lo. 'o rctrrrucl rlE Fr]lcl isd 7014, &6n6 En Aoks{ ( o& Tt Conu-ior.! L'cdk lrtr d(E mr !p9l} ro d o}c olFoFry s h. noildr or mprovBlh6@n. md !tk' .odftr.f 3u.h F.!rs "nh ! (ndfto(rl ltau.n FJjlld b !,F Co.ir..lo r I -.* l^ ) I m.rmr, un&r Sdrio.,-/- " !t! ( l \Rrrr0\ Ih.'.h\ rlli'tr' trtr(1.' lttrrll\.rpoJUn fn..lrh. n,LL\\tr,N Li(lrr nn$ l havc ml $ ill mainrain a C.nificsle of (inliol k' s.lf'l BU,c Ior s ork6i .lnrpdsr nJn, s lr.\ id.d lu bt s(tion !70(r or rhc ljho. (irh lorth.!€fommcofth.eo* lor shicnrn.,qmi! ir i$ucd I h!v. rRl r il I h.inliin u o,kd' comp(sr Rrn 'Buratu<. {r r.qu'Eil b, sRrion i 7(xr .f rh. I !t$r (ndc. fo, th. psf.mift. of th!*o for qfi'chrh! Fnn i iqEd M!*o 6 cdnFdion 'NUre.sE ai lrlEr_ nu.rhq s. I cdlfyrl'.l brh.pstolrrffi.of rhcuort loruh(hlh6Fnn n saL l3h.ll mr mplor mr, rErsn rn Mrmd6 $ s ro b.<.m. ruli{ir r. th. so 6 .ompdd i.. h"a of c.|aomia sd lsr lhd it I itr,lld tEco@ 3uq.d to rtE Bo 6r.omFutionpmvtioEolsc-lionl?O0oflh.libor(o&.1{Ell.fonh*irh.tnpl}$dhrlklklmliioDs. wALNtN(; f.,lurc ro sr. No.[6'.omp.Mi.n c.r-qr i! unls*ful. md sh.ll rlbid e oploF lo sinin.l p.shi6 and .irrl lin6 op h on. hun&.n lhousnd dol srt1krn 1r)76.rrh. r.h.r (-.d. inrEd Md l \ tll(r0.(xxr), in ddiFn to lhe f. ,lxn r$ n: r"!rtlil nr rh( I reFra llfm und6 Fsxy ol Fru.y rht I m lEqkl u.& Im\ thn of Cluda 9 (mmnEc'ns s (h sdlM 7000, oa Dn is6n 1 or rh. BuriB bd Prcf*sa Cod.. rJ ny lt.B a r tull rorc ai .lld I '.ai. Numb.r' _ IaIjiITIJSIONIITDIIC-AIIi!(I I hs.by rllrm und6 F allyofFrjur' rhrl lhrc i5 ! co.rlruclon lddns aracy for lh. pc nnn{n.c oflhc sort nrt shich rhis t imir i! i$!.d {sd 10e7, cn (-). I d.id ! N n. Aftu(lxlDEclJaallo! I h.!tr.fiinqnd.r Fnrhy olpqjur) oE ofllE folloqin8 &(la iont Donnisn Pomiii Asb61o. Noriicnion F.d.trl R.8u hr6nr {Ink .r0. Fan6) R.ttuiEd l.. d of Noriff,diotr I alllN r'.ondy tr irh all C'tl and (irnry dn6 ofthis (-(v.nLl ( otrnlJ_ ro drd qFn d'. Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Subf loor/VenUl nsulation Roof Sheathing b/? /i .,,1D-1r1) Shear Wall Framinq lnsulation/Energy Drywall Ext./lnt. Lath Brown Coat h,4a son ry Pool Fence T-Bar Handicap Req Deputy Final Report Engineer Final Report t0lt)Llt? a.vc lL?ll.,t 4' Certificate of Occu p;n-- Notes, Remarks, Etc DATE v \4,'<..- v 4<.--\ I I I I I I Flood Zone Certif . FINAL