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APPROVALS DATE ID/SIG.COMMENTS OWNER EUII,DDR DET,('ARA']loN I ha.t,.flntu und( p.trAhy of p.rjury rhn I an.rdnfl frorrrh.(onrricro's'l.icos L rnyrh.aoll \iDr rcarr (Sd.7oll5 Busin€s and Prof6sion C.d.) Anyanyor Counrt $Ii.h r.rtutr6 d tmil k' Nnitucr. !ltE. imnrorc. donrl'rh.r Elst dy (ruclB.. prior to ns isu c., ale rcqonB th. optlicatrl for n,.hF n ro fil.asittr.J nnrondr rhd hc.r sn. a li..N.d puedl lo lh. proririons ol rh. conri.ro.s l-i.di.d l.aN (( haDr( 9- (irnrcn ins rnh S€(ion ?tr00 ol l)n ision I .frhe hBinN ed PlofNio (od.).rlh.rh.orshcis.r.mflrhe.fromddrhctEsrs,irrhcallcg.d.ronprion nyrioldrionofsdionTlrll5 by rny lpplicantlor.FflnnsubjcGlh.dpplicanl'or.irilp.n.hrolnornk&rhtuljv.htr.Ji.rld.llrist1500) _l. B owMofrn F.Fty. or my.mplor6 wirh w!8d 6 thdr $L coop.n dion. sill & rh. $rt ind $. sntlE ! mti s!d.d orotro.d for $L{Sc 704:1. BsilB dd ProftlrioBCodc Th.Co.'lr.croi! LtN l.wd,6 ml.pplyr. so*Gof lnc FlFty who lxil& d iigrs6 thadr dd *ho dc sch wn hirulf or h.elf or ihEush hn or h6 own mphr.6. prcvi.Ld lhi t!.h idporqElr! e mr idald.d q o&!d tu, bL. l[ ho6q. [E hildins o. irsol€G'r h hld *ihin an. )r ofonpldblr dEorid Blild(r *illh!* tlr hldor ofF.vnu rhr lrorlhcdn @l h d r inlg.!v. $c FDrqty fM tlE purpo.Gof l. a osc oarh. pmp.ny, M q.luri!.ly .od.&1i.9 wnh li.d!.d coitracroB ro disrtu r llE pmrd (Sd 7014, BBin6 rid PEto d Codc: Thc Conmdorr Licd3c L.w dod mi.pplyro rf, owr6 ofprcnslywho buil.t!.r nIpmvd ihdsn. bd who o ri.i! ror tuch FDj*r3 wnn r Cor&!.lo{, lkdB.d p!6ud ro rh. conr.clr't Li.dg L!w). I m.roD| udnsnrion .1,. & P.(. for thir rmso \t(rRKt:Rs'( o\ '[ifrs,\ I t()\ DU( t.'\llA I ll]l I ls.by arum !nd? p66lry of psjury om .alh. aollo*iig &.lurioB lh.\.rnd\ill'nrinr.in r(ni'ic.r.of(i,is.nrro ScltlDstrrc llrr(ork(r conrtmv!qr..s tr.\ntd f(r h\ S.!ridtr rrl)0otth€ tjbo. ( od.. f{yth.tEfonnanc.oflfi.\orl ftx*hich lh.tErnil is is{r.d I ha\.nnd \rillnran iin \ort6i confansatnrn iN ranc.,N rcqrn.n h! S(li('n:1](x)olrhe l.ihor (ode. fin rtu nnhrnMc.ofthirffin n isad Mv q.rLd' .onlEdi.hAttU, Ziura,oc-e iEuruft ffi6 d lolicy nuhb.r E ,^.,", o,-L-.4d4-L-SE L o "::,":^:':,,,:(k::.^.-l cslify thd in lh. Ff.mrde olth. "orl f.r shich rhi! pcmit i. i.su.d. I $ dlo bcom 3ubjtl lo th. worl6 mmFE lion l.wrolc.liaomia rnd.graihd ifI should b..orc rubjd lo trE @*d conpnsrion phyLio6 ofS.dion 3T@ otrhc llbor Codc.l {Ell. forrfirnn Nmply wirh th.FDmvisn nr WARNING: Fsilurc l. snrc *orls' civil ,ii6 up ro on huidd rhowid Seiion 1076 ol rh. ttbor Codc. intcBr mnpcG.lion cov6g. is unllwtu!. !.d shlll subjd dnplorr lo simintrl Futil dd . {'z I hd.tly.0lrm unds p.nolry o f pgjlry rhar I am I'cqsd und( Fovision oa( haprq I (co'n'nocm! s'rh sNri.n 7lr(r1r).l l)i\i!io.l of th. Busin6s ed PmlsioN ( od.. dt 'ry lic.s i5 in full lorc. .rd .fiEr, B csl Stlz.<o 1-Zt-O @ fuJe cruk to!ffaucroN-Lllt lxc-ac[N(r I hRby!fli undd F.llyof pajuryrhd rhs.t. snrMlion laldints.8dcy forlh.FaoflMnc. of th. qort for rhi.h rhis Fnn i! i$ucd (Se 1097, Civ C) AIIIICA.N[DECTAAATQ! I rE!|* amm undd p.n0lly otFjury o..otrhc lollo$inB d{hrdrirtrs: Donohion Pdtr!tu-AstBros Norificarion lj.dd.l R.8trld ion. {1 ir l. .10, P0n6l R.qut.d Ldt6 of Notifi cdlhn r.g8{i.U ah6rG imvrl nr. mr .rpli.!bl. lo rhi p$j.<i. ndc rh6r rtu atFv. iifonndion ir cotrc.1 I 'srE to conpl, n'ith lll cirt and ( 6unry is.byourh.rtir.Ir6nrdiv6olrhn( ir,andC.un'rro.trrdupo. . rbovc @lionql pDpqty fo, Appli.nnl orAtenl Siqnitu ,,,","'l'/l'l/ P.mile nrne (prlnr) lC f TiqamtY UNDER GROUND Waste & Vent Water-Under floor Is Jt,W ({t) Gas-Underfloor Building Sewer Area/Storm Drain lnterceptor/ Clarifier / TOP OUT I Waste & Vent [. 'C&61'. ,n"E1lrc{z,nJ Water Piping t"yt' Gas Piping Roof Drain Tub/Shower Test Rough Water Heater POOL/SPA P{rap/Drain Line Main Drain/Pool Pipinq Fill Line/Back Flow Pool Healer/Gas Line Gas Service Water Service Lawn Sprinkler Sanitary Sewer/Cap Back Flow Device Rough Plumbing Final Gas Test Meter Release FINAL Notes, Remarks, Etc. -?t-t .s PLUMBING-INSPECTOR RECORD 5-tLt,l *-11 Miscellaneous