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BUILDING. INSPECTOR BECORD
<br />SITE.WORK DATE ID/SIG.OWNER BUII.DER DELCARATION
<br />I h.Ehy rlrtrm uBLr Felty ol lErjury lh.r I .n c\chpr fnh rL Cohrr&rF Licns Ir* fot lht n bwin3 E.r,tr (S&.?0.ll.l
<br />Itusfts .,n PnL$rrn Cr!): 4,, C , or Coonrr ehrh E1!fts . Fd '. enrnkl. .h(. ir{,ot. &d sh,r qfu uy
<br />{turuc, Inx ro t !1u8.. rlg' ElluG rlE .t't ..nr for lBh Fmr io r,k t s,!mJ {r.m.r rhd h. or aE a lr.nGl lus.rr
<br />r. rh. Ir,vrDns ot rlE Coorrukn r l-i(..kd Lrr lch{r.r q, ColnmmrS etrh Sarxr ,ujo of Drln$n .! of rL BrsiFri lnd
<br />PNtc*n'nt Cod.) or rhrt h. o. sh. ii Gr..q{ th.rcrron rnd th. b.$r ltr rlE rlLscd cic,ryri"n Any vnlLh.norsetrln 70ll.s by rny
<br />rprlt.nr itr . rtmr qbFir rh. rt rlr.nr t, r uvrl FMxy ol hor mr. lh.n tivc hu r.J dolLn lst0)
<br />Lrso*rcrofrlEFFny.qnr.trIploF<girhw.B6.rrrErohon{ENrstrwil.bl1lqrtrnlh.{n!rs,
<br />inlcnlal or ofi.E l f{r sk (Sd.?044, Blrid$ in,j rtlnc*ioN C,rlr: TIE Conr&ror's Lj..nc L.! drEt nol !pfl, lo !n omr trf
<br />E Fot'dl, *ln hril& * DrroB llE q^ nl wh, &B $rr u,t hilMlf or lElf,tr lhnu8h hn { ltt om .ry{t'Fd.
<br />Fltilol 'h.r uh ',rtmErdtE rr ln.nldt ixollsul tu eL lirnkq.ttt itlB d Fl)smii !$!r.hom)..,
<br />ordrqt*n rtE o,E Bu'lk*dlMhiEh,{.nolImvltaUdlEq{Elndhnll.i6rtoEuEFId,r trE F,Fror
<br />,1. 6.smr or rrr F,Idy, d.rclurwl, conoaro8 w h 116.!..nll-nB lo.!n{Br E,FFr(Ss 7044, Busrs
<br />jrl hbtsd CdL Th. CnMrorr l-f,..r bp *B Nr .t?ly k, D.*B of FDF!y *ho boJ.lt or lqrhw. th.rdtr
<br />.l *hl conttur! nr *t FFr! *'rh ! G) tuonn lto<! |{a@r brtE G)drtuh.l rtd€ Lv).
<br />I ecr.nrluBlcr Sdrhtr-, B &PC lorrh(ftrq,n
<br />.ua86EES:i:{rUfEdl roN
<br />DECI.AMUqN
<br />I h.r.l,y rlunundcr Fmlryol FrprrorofrM tull,use &Ll'hrhhs:
<br />-l
<br />hrE lrl wrll mht.m . Cdfr.lc .f Consd t' Scltlnlur |ltr krldr .onqxhsr$h, ri Flvrldl i by Sarrin 11I) ol th.
<br />lfhtr C,ilc. tn rhe rErrormncc o, rh. wod lir, sh(h
<br />'hc ltrh n NU.d.
<br />_lhlw!&l* l m6tr wortd.' rnnF.N.lrnNrr.B., .. r.1lu!ql hy Sclkm]nI)orllE Lt Ci'L. ror
<br />'h. Fr(),ria.olrlr k*t ftr rhich rh! IEmr s a$d My rsl6' orFtrt lr. irue! GE d i,lx, mnh.r &.
<br />e <.r- tc e o- /2i.zAt---^ L,L.J
<br />o.ooz\ o)2c)1Z
<br />_l.cn,ry thrr in th. Frrormrc or rlE *orl tu wh.h rhN I.rh( 'l isrkd. I sh"[ mr.n, oy my Fron in.ny h.nmt
<br />$ $ ro tEqrft r!hl.(r n' rh. w*16 loqrB|ti'n l.es olc.liLmir. rnd t8N lh.l if I nrr! b.Loft ol,irr brlr
<br />kddr s,r{f,dri'nFrvtbN of sdbn }nxJofrlE L.lrr cftL,I {dl. rdrh*ii[o,ltl, w hrhd.FilsoN
<br />WATNIN(;] FrluE tr sE wL6 .uFBtrh oms. u !.L*tuI. dl nul shFr d.trohF ro dlllwl FflIir r'll
<br />crI rh.i un ro oB hu lEd lnouurl &'ll$ (t1m.000). h ddir$. io rh. cod or.1,n!E.elk,n. J.m8.s n ,mvnal tu ilE
<br />S.rrir r 76 ol rh. l.rh, (iil!.. tr .'.n
<br />DECIJEAIIA!
<br />Ihcrhysl,irnuridc!Fnrlryofp.rlury lh2ll.m lilcnrn unncr t rnn,notChafl.r9(ro mk'n!* hSc(ron?Urrr"tD,vr{on i
<br />ot rh. llurkrs rll Pn,rcrsr6 C,rt, .,n n, hc.s is in full nnN lrl .ltul
<br />r,..,*C'rr,.' D -l
<br />'4^ l- z
<br />galtrBucI[8.tENDA{i4{iENCr
<br />I tuEl,y 6llth uBLr FMlr, oI Frr!ry rhlr rhcr n r Linnturrr kndoS r8.tut ror lh. Frr,mftr ol rlE q i, lhrh lhs Fn tr
<br />nru<rl (Js( l0.rl, Crv C )
<br />Ldl.r'r N.E:
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<br />ADPLICANT DIiCT-ATATON
<br />I hcEtiy rnim un jcr pcnrlry orp.rjuryon. or lh. nnl)*ins tLrhrrrx,ns:
<br />DctuLri). P..mik-Ash.ios NoLlicttion ft,lcr.l R.3uhrioN (T'tlc 40. Prn6)
<br />Rcqulsl klr.r o! Nrfulu
<br />I Nnilrrhur rhc ridcnl rcFhri,,n\ rlddD! srh.i.!rcm,vdarc not rnnli(ohlc kr tha I'n)Fr
<br />tJc.d,ly rh,r I ha\ rr.l ,hr l,plrrrrD ri nrr. rhr rh. rb(,E otomLr B.l'r._.r. t 4R lo.r.mly *nh iU C'r, rd Cour,
<br />.l,lmB.t rd skrc l,s! ELrry t, horrlms.od&1rq r!,rEtt:utlbre i.F*n'.twr,n rhr C y.dCou ,h.nrdulrrr&
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsu lation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/Eneroy
<br />Drywall
<br />Ext./lnt. Lath
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certil
<br />Ac-
<br />Frl.rAL 1/*+*ln &<4/il29 LrJ
<br />Certilicate ot Occupancy
<br />Notes, Remarks, Etc.
<br />COMMENTS
<br />D.t,.ll-l-'z \
<br />tr lcrx An&cs
<br />Brown Coat
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