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DATE ID/SIG.COMMENTS OWNEX AUIDET DELCAR TION
<br />I lErctry rfrrm ukicr FMhy (!f JErJUry lhrr I m.rcr{i ltuh rrr Gn rGkn lr.r Lv for rh. rrnkivn8 Er$n lS.L.7OJl.5
<br />Bu\irc$ !n tNfc$b. GrL)r An, Ciry or Cnudy whah r.qu,.s r Fmn b .onslrud. .lla. r+n,w, t!.mlnh { rFu sy
<br />iurw. Fr l. nr Nlrer. .!ro Grw.t rlE .ntlld ntr !o.h Fmr nt ftL r rrrEn nr.md !h4 tl or rlr u lkorn Fasur
<br />rr rhc rn,v6on! or E Conrja(tr's L&nr.t bw (Cnll'!c, 9. Conmturn8 wrh Seli,,n ?mo or Dirisr. I or rhc Bus'mss D.i
<br />thr.s,rns CuL) rlh.t lE drBckmd Ercrron.ti llE b.!! tu tlE dl.f.ri .r.,qrirn. Ary rnLriD or S{rDn 701I t b, .n,
<br />ir,i'r:nrttr.Ftui:!hFGrrr.art{.nrb.w'lFEhyofn B,E rhrn nw hutrl,rrl ddl$ ( ts(I)r.
<br />l. .! .}Br ol rlE FnFny. or my .mploFt w h *.8( .! llrr e'L .!mp.n5.ri,n. *r! &, rL *rrr rnj r,! {BiE tr br
<br />orcBhl or ollcrn fq e! (Se ?0.14, BurE$ . Pmld$,nr Cd].: TIE Cofiarr\ t-rcni tiw &r. n, rtfly i' tn oltr or
<br />i h. tlr,Fny wl$ t{ iJr r mlB)wr r}EBu url wlD J.Ec rLt k'rt tun\clf or h.Mll or rh^ru8h hk or h.r oen cmni,y.cs.
<br />poy!.J rh:r ruh lqn,wdt m nn ddrl6l (trofldrl tf, eL ll trMw. tlE t{din{ lqrME ss*lsnhm(nF{
<br />ol !$rllLrs( r o*Br lr!,tlcr e l ME rlr iulcn ol FlvDg dgl lE o, slE d!.1 ml h!! ff !t{rM 0r trFry nn dr F{Frr or
<br />_I, ( ormr ol rh. I)n{rny, rd .rrtuskly co rlrr 13 w h l(.hkd .onu..trE rr d,tr\Bl rh. F,t d (se 7(}1,1. Busrs
<br />.trl th,lilrrr Cdlc: Th. Conrfu.l,tr's l-i.c.r t/* &rt dn rlply ro u o*".r of llr,l.dy rtir buildr ot ihnolcr rh.rotr
<br />rnJ *ho odd.ls (* tun FrFc w{h. C({rrkx, lr.nGl FBd ro E 6nurtr'r tr.n( L.rr.
<br />_I rm.kml'r trLlci S(rxrn_, B. & P.C ntrrhs rcrson
<br />raf,5[&tglll8rltArla!
<br />IEC! AEArrOr
<br />I hcrchydllrmlricr pcnallyol Frlur,.E!lrh{ I'nt'w,nt J.ll.rrrDns:
<br />I h.E In w l Dnr.n. Cdnill. of Consnr ro S.lllNE nx q,i6 Luiiwr,n, a Frqldl lu h, S&rin lru or rlE
<br />Lls<.xlc. lor th. Fnornldc nI rhc *rl lor nhr h thc Imir a tr\u.J
<br />w.l h.K rd wrll htr'n Inrls Lotrr{Mrxr oqrBc. .r cqo,6l I'y Sdri,n 17fl) ol r,E LrM CdL, ror rlE Frrdrm or
<br />xnd ! N{'cJ My $orl.,\.onlI(h:rk,, trtrrr}n(. rmi.r {rl F'l'.y trtrnrh-r d.
<br />Kr-r.r.dr-
<br />Q\ [oos (3
<br />_lr.d'fylllar 'n
<br />rhc fLrrortunr.o, rh. eolk ntr whrhrhrFrmn r ssudl,I shrll frn cm!!'yrnypcs{ $rnymrnrcr
<br />$ a kr tEtom rubFll lo rlI *tltai coqEnulk'n L$.1C.lnon( .rn .3r rn:t I I .tn!l] l\{om suhrd ro tlt
<br />qrA6t rohlFnsru pn,vtrr'ninfSdrxm 17U) o, rb. Uh{ C,rlc,I shrtl, tudhwlh (rrr{'ly vrrhrlrM F vrr)B
<br />WARNIN(;: Firlu.c k, sE ktrkcG'dmn nr.rDn (.v.n!c rr unhwlnl. dnd .hdl hl..r u cnpn)Fr t, diturl Fu[i( .nd
<br />.Nrl nn.r up !) oE hu.dG.l rhrqd JollrB rtrdr,ux)),
<br />'n
<br />rl]d$n tu rh. .o{ ol o'rlinqrxn, Jm8.! rs F.vrl.d t,tr rtr
<br />ni.r.( rnJ N omt r irlo
<br />DECI.dSAIIOX
<br />I rEr.by .rl 'm ud.r Fflhy ol Frrury 'hrr
<br />I m lr.n$J uuLr Fuv.nn of Cli.prs 9 ((u,leEot wnh S<rrr 7u|l] df DtE.. .r
<br />ol rlE Ausft$.nJ Pn'f.shnr C,rlc,.,n hylf,.nr ir tr tull fo^r dcfinr
<br />o44c\b3
<br />o
<br />colslalsuqN.LlBDlNG-ac[Bla
<br />I lrEl'y rllm unLr Fulry d, Frrury rh.r rhq. ir r .unru(tirn kd s r8.N, lt rh. Frrolrl*. I rtE q ru *lkh lhn Fmr !
<br />r\$cd tsa -109r, civ c.)
<br />AIILICIINLIILCIASAIIO!
<br />I lratr ,,imtald ltrrl, of Fr,lryor ol lhc l,,lk,sn8 !^Llrrrr)n!:
<br />I).Rrd(,n Pdmd!Asb.no!Nor,irauonl<l(rl Rcruldrhns(Tirl..qr. Prn6)
<br />-Rrquu.d
<br />1. ., o! l{rIi.{rnr
<br />_l ..nil, rh:r rlx lckrd rqrhr[nr RBdinB ritirtx kfr)vrl r. n, rmlk.hL l,i rtui Flrd
<br />Iccnrlyrharlhlvcrc.drhs6pt'fu6l[n! (!ldl'al lhc 6h)vc rnr('mxon x.orcrr la8i(ro$nrdyrihlllCirrrndcounry
<br />oiltuE.'.! rnl Srr. trwr ElrtnB !' t{ilJng on{nkriD rnl tE chy.urntruc rqrc{dlliv.r ofrtu Crr, {rl Coury n,.d6 nli)n ilE
<br />rtr,E EnrDNl pn{Eny nr BFdr'.
<br />ADDli..nr or ,\t.nr SiqNru
<br />^.
<br />Set Backs
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsu lation ,a
<br />Roof Sheathing z/2/e/tldlfrd cg
<br />Shear Wall
<br />Framing
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certil
<br />FINAL Z4s r?,1 2 Oa ,/€/o5 dZV
<br />Certiticate of Occupancy
<br />Notes, Remarks, Etc.
<br />BUILDING. INSPECTOR RECORD
<br />SITE-WORK
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />IhGr-
<br />n?la'1
<br />/x
<br />lal{ta
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