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SITE.WORK DATE COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subtloor/VenVlnsu lation
<br />Roof Sheathing
<br />Shear Wall
<br />Framinq 'a Lfr Wl
<br />lnsulation/Enerqy II
<br />Drywall
<br />EIUlnt. Lath I
<br />.)7-o >rffic L *Ea
<br />'Brown Coat \/ ScOrlCti'/(waz,'i8 / z.lElza -tarN6L4n-Masunry-lt
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certil.
<br />Le*FINAL 1 t1 1O
<br />Certilicate ol Occupancy
<br />Notes, Bemarks, Etc.
<br />fri-L ,J(a*-warl 0
<br />tl
<br />7ttIlr
<br />OWNER BUTI-DET DALCATATION
<br />I h(rcby dflirm ! $tE lly.l Frjury rh.r I M.rcrl 6t,m rlE Gr ranF'L!qr llq rMrll tulldvhs Grah (sen).tl t
<br />EusN( !n ProLsn'n Cirk): Aiy C y or Coxnry rhf,h Fqu8s I Ftu n, .nncru.r. drcr. rt rn'v.. .].mlah n EP.r uy
<br />tlqr r.,tucr rlx fllrrr t' \Nh Fm[ t, lih . r{ftal drl.trn! rh.t lE or slr s l(cnkn limurn(
<br />rar.i. Lr.n<-l tr* (ch.fl.r e. ClmmLmE *nh SNrxtn mlLtl o,t(x,n I ol rrr Burms J
<br />lror \h. tr.r.nrr rh.rchomuJ rhc hJn\ l(trrl* dlc3.J.r.n{rtrr Anyvohrtr)nofgdrr)n70rl5 hy.ny
<br />rubjdc rh. rlt f,.mr'.ovrF hyoffr, mrcrhr lrvc hunlEJJoll{s tl5m).
<br />\gf!r o*8. or rlE rroFny, or mr .mFrorr.s u h uitcr .s ih.ir e,k cotrFN.ron. q d{ I
<br />ddrlal !f,dll.Ed nrs!(Sa 7044, Burrrr rft, PmE{rnni ccL, Tn conr*iqi Llm< uw dd fr, .prly lo.. owmr ol
<br />rh. tn)Fdy wt$ t{ ! or iri|mw! rlEotr ril *hd &- rh sf,t hmclf or lEmll o. rhNu3i t! d }s om .nploy..t.
<br />rovrldl rhrr rkh nlnitrdr E mr rlcniol r oficrql rir s!. lt h'kE, [r r ND! ,r nfmEmnr ! s! wirhd w ra
<br />or dxrplcre rlE ()rE 6u&r *iU lrE rlr t$Li ol Ftus rll.l lr u ttr Jn d, hrr! n !4RrE tlE FoFy fti rli ,rrFE ol
<br />L ar ouftr.trlr Fr.ny, s.\h$rlr.odrrrDs w h l(nel $ .-nn !, on(tur llr F,Fi lsa 71xrl. B!rm(
<br />lri hr6an CoJ.: ]n.Co.kldorr Lr.nr.Lrwd,ri rn aptlylo sovn.rol lroFdr rlx' burlk.. m!ruKr ih.Nn.
<br />..d *h odtuts ritr sBh rrujdk r'rh r Codtu(4n l[.nd fuftlrd l,,rkcnnlmttri lrcns l:e)
<br />-l.m.rcmfl
<br />lnnerSerDn-,B & PC ntrlh(r..on.
<br />I t.l ", 1s Y]1--vt O I -08 ?i,'2<).w
<br />I h.'.hyrlltrn,tran.r Iitrrlryo, BrJUryorkdl rlrI'nL'*trr! ilNlrrn! \
<br />-l
<br />hrvc an will mdidn r C.nifrrrc ol Cotrknl lo S.lf-lnrnE lix *xI6' (r'r{ndDh. rs FDvdai nn t y Sarm l7ttr of rh.
<br />I rh, cdk, ntr rtE Fromn. ol lrE wo* for ,hih lhc pcmi s nrctl.
<br />I luvc unJ *rll nurirm *orlGra con{xn<rrDn mru.rBc. .r rclurcJ hy Slri,n .!r(I) ol rh. lr&, Arl., ntr rh. IErllm. of
<br />rh. xrk li, *h{hrhr Fm( rs.ffit Mywolt6 .r)m!ns.ik}n rn{mNcrs{r sil rhl'.y 6umh.. E:
<br />.d'lyrhat mrh.Frlnr rcolrlEq.ltl,ruhihthtrp.rrn11rn'.J.I\hrllB.mtk,ylnyJEronr ynr{m'
<br />r' I n' b.(r'm ruhr.r h rh. hrl6 .rrtinarrn E t or Crll(ma. nl r8r rh{ d I rtrll tEror rubj.rr i. rrE
<br />w'*€(, (,mncni.r!)n lmvrr'tr! oi S.cr ii'n ]7Ul of rh. l:htr C*k. I rtEll, lulh!( h .r'nPly wirh rho. Frvsx,.s
<br />WARNINC: lrnnr n, roF s*t6 $nFrqrr'..o!d!. r. unL*tul, rnJ .hil rubFr .n mflor.r nr diMrl lorlrn lnd
<br />.'vrl ltrrs uI n, oh.hunJr.J rlu,urdrl Jolldr r1l()), h s! ir lo rlE .on dl corlitrqro( &m3cr .s ir.viri tor rlF
<br />SRri)n 10?6ol rhc,rhr C,rj.. r .r.j dd.lltrrRy
<br />.0 H k-!"ot- o6.20Zo
<br />I hcrchy rllrm u*lcr pe lry ol FrJnry rhr! l :m Len*l unLr Frvsrr oI Chttr.r 9 (roMrin! w h Sttrn 70(()) ol lrvrFn .l
<br />ol rlE aurmlr.rn Pn,lc\!i,ns C{iL. hl mr l(.n{ tr nlullfo(tdnd.ller
<br />galtl8!,tllrll!.tllDlNc-{cEN;r
<br />I lrRhy ainm ud.r p.Mlry .l JEl|r., rh.r ilEr i\ r LrNlru.rln t BihS +dy fd rh Fnxlia. ol lh. srt for $luh tb6 Fmi F
<br />nto.il (s&. 1097. civ. c,)
<br />L.rj.r'r N.m:
<br />-
<br />L.nLat ArlElr:
<br />-
<br />APPT ICANI DFCLAI]ITION
<br />Ilrntyrllim,unJcr ptnrlryol n riury.r I rh. ltll,wi,3 LLll,.ri,n\:
<br />Dcnrn i,n f.rflnls- shcdos NoxrMr('n R,,.rilR.tulrrhn. (T k (,. Pu(,
<br />Rrtrtr.d l.drrr,n Mi
<br />ilE lii.rd Rrll,r-hr Eralm8 (ltrt\ rcmrv.l e ftn rl'r !$k n' rhr FrFi
<br />rh^intlrrrrrdlnrr.rhirrh. rhtr. ,loflnrrur tr.or..i li!r(r,(rnplywihrll(\ryrr!](r'utrrv
<br />ELrDr ro hriuus .ondei,tr rd ls.ri, rlxre EF*nr.tv.s ol rhn Cny .n Co!n, t' ..r( UFE rlE
<br />ot- 06' 2c Lod,.,L/'
<br />BUILDING. INSPECTOR RECORD
<br />ID/SIG.
<br />D(try'tcr
<br />l)Ann r)
<br />Ihl.
<br />-
<br />Co mlor:-
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