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SITE-WOBK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Sleel/Holdowns
<br />Ereclion Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framinq
<br />lnsu lation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />It4asonry
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif.
<br />,/./ 2n //4 ^*4ncertificale of occupancy 7 7 ]=a -V
<br />Notes, Remarks, Etc
<br />\
<br />OTVNER BT'II,DNR DFJI,CARATION II h$chy rfllrm unddr ltndlry (n p.rjury rhrr I a'n ercnrpr lion rhc (iinrdtrJ Li.cn$ tjw f.r rhc lolbwn8 rcr!,n islr ?u1l 5I
<br />at\iDc\. ind tft,r.\\nJn C.J.): Any Ciry or G,umt uhrh r,lrir.\ r p.nnir r. .on{tu.r. rlrcr. nnprorc. dc Fli\h , r ftnJn rn} !
<br />shcrurc. rionr ils isnrucc. rl$ rcqunc\ lhe upplicmr fn \uch p(nllr t, fil.a \isncd nd.'ftnr lhd ncor shc i\ lic**.l I,,",-,,
<br />b ih pm!iln,ns of rne G,nra.trn's Li.cd\cd ljw (Chnprcr 9, Cunnn.kirs rvirh Sccrion 700{) of l)ivi\i('n I of rhc Btr(incs rnd
<br />Pknission\Cod.) orrhJr tEor shc hcxcmpt lhcrclionrrlld rlt b0\is iitrihcnllcgcd cxcm!ri,D Atrrvi,,LrnnrofS(rionTlllll 5byrn,
<br />rpt'licanliorrrcnnilsubicclrlhcll)!li.intlorci!iipcnaltyofnolnncihMiivchudrdddollts(S5(x,
<br />-1.!\osncroirhcnmp.ny,ortrrycmploycc\wirhFrBc(n{lhcir$lcconrcnsrri(nl,qilld.rhcqo
<br />flnrhcdnKrnrcisfrn
<br />nrcMcJ ororlcrc tursnlc(SN7(!4. BusincsotrdPi. t\notrsCod. l hc C.nkrcrt \ Liccn\c l-rs' drf\ nor sprly h r. o{1$ ol
<br />rh. ptr,Fny wllJ hikh or i'{xoK\ rhcruon. x'{l$ho d€\ \uch *o'k hi'n{lror hc^cllor rhflnlah his or hcr u*n cD'lloyccs.
<br />pmv'dcd rhar such inlPn,vcf,xnr\ m nor i'nc,rl-d or oficEd fd slc lt ho*!vcr, rlr huildi,U or i'n|, !rcnrnl n sB wirhin nn. Fr
<br />olcom0lcriotr.ltE owner Buiklcr willhaw rhc htrdcn ofnn,vins rhrr h. or shc dkr tror huild or inDmvc rhc rDpcny rar rh. Nqx,{ ol
<br />l. r\os cr orrlr pnr|f,ny. rncrclusnely.ortr.lirB wirh li.crscd conrrnckrn t, cun(ru.r rh. t,micrr(Scc.7(!t- Bu.i',r\\
<br />did lh)fsrai Codc: Thc Coflr.ciols l-ic.nsc Lnw d.c\ n.l ap,rly ro rnosm. of l)n)lcny eho nuinl\ or nnnrolc. rh.r.on.
<br />rnd who.onnrchtusuchpn+.r\sirh!coDta.tnr\)liccn{dpus!,nibth.(rnxErq\l,icctr\clf,w)
<br />I nn.xctrrpl trtrd.' Sc.ri{nr . B & l'( lni Lhi! r.n*{
<br />Dol.: ()Rner:
<br />wonxiisirirrprill tior
<br />I)lig.r&tllax
<br />I h.rrhyrllnmunn.rpc lryuf Dcltrry.m.lrhcldlostrlldc.hrdion\
<br />IhakrdwillnDinhirdCcnificircolConscntloSclilnsurcl'orsorlq!corFcn\rtn)n.isprovidcdlbtbySstn,n.l7U)ofrhc
<br />ljhtrCodc. t)rrhc pcri.rmnN of rh. wo.* lnr $hichrhc lcnrir is ssucd
<br />\l hNc nM sill nkmrar Borkcn conrensarion inslrrmc. rs rcquiftd ht s.rrion lTrx) oirhc Lnhot C.dc. ror rh. Pcrr'onmncc.l
<br />lhc work for which rhisr.irnil is issucd My*. cr'corlpctrsrrn,n inrunrcc.dnicr ind policynlnrbcrue
<br />*
<br />,,,., Ev(ro@r-l i.h-honh. h4r!,/tFr\gE fo.
<br />76 oooo lLlz.lt 0l
<br />-ryrr*,
<br />b / t ol
<br />-lccnify
<br />rhrl in rh. pcrll)nunc. ofrhc $ork nr whi.h rh,\ rcmir ir i\$'c(|. I shrll nor rtr1Plt,y rtry Nron in i.:i mrnncr
<br />$ N r. hccoE uhjcd b ihc *o 8(..n$.ns[i,)nlnssofcrlil.nrir.rnd4rcrl r if l sh.ukl lr.onrc suhrcclbrnc
<br />trorkcs coD|Ens ionpmvi\ion\ofsccrn,n:lT0oorrhctrhtrcodc.l\h!ll.tunh*irhcoardtwlrhrhotlroYision\
<br />WARNIN(;: F!ih'c t, {.urc workcrr'.onrcn$lion covcrllc is unlrvtul. trid dr.ll nrhjccr !n cnPhrcr n) dirnitul Nnr[is a.d
<br />cilil fincs up n) oic hrndicd thousand dollds lsl(xr.(xD). in a{lJiri{r t, rh..o{ olconrPcn(alnin. {hm r.\ r\ p(,vidcd tur rhc
<br />DECIJBAII!}N
<br />I hcr.by llirnr utucr pcNlly ol pcrjury rh,r Ln lic.n{d unl.r pnrvish ol Chlplct 9l connf, . ing wirh sei ion TO[D) ol Di! ntD -l
<br />oi rhc Ansincs and Prtna\\io.s Cod.. !d trry liccnsc i\ in Inlllorcerf,dcffccr
<br />{ ,,-...^,,,,*, fqq A71-
<br />K
<br />Lbt 0 L
<br />,"/ro/,c
<br />coNsrlll lcl !()N I Fj\DIN(; a(:ENCY
<br />is{rd (Scc. 3U)7. Civ. C )
<br />Ixtrdc.( Nanrr _
<br />hM$'r Addrrss
<br />-
<br />APPI I(:AN'I DTJCLARAI'ION
<br />I lH$y rlltm unilcr ncnalry ofr.rjury om of rhc hlk,wi.E d(hmrions:
<br />DcnnliriNr PcrnrirrAsIE(o\ Noriicari(,n Fed..rl R.Suhnnr{ {Tirlc 4). Pan6l
<br />Rcquncd L.trcr ol Norillcarbi
<br />I.crrifyrhJrrhcLdcfllr+uhri(,\eF dirrBn$cr.rr.N,vrlircnorrpfl'.rhlcn,rInfoiccl
<br />o,d ftnrc\ r d Srrc l.sv\,.Li[! r. htriltltr,! r.n{n'(i lh.rchyrurh.ricrcrrcsenrxrivc\ofrhi\Cnyr Couniy n, cnrcr r|ln rlr
<br />xlniv. trkr ono(ltr)tf,nr_ lnr n\t)..[{] trrts\'\
<br />lvtT?
<br />(,/of rug
<br />BUILDING- INSPECTOR RECORD
<br />Pool Fence
<br />FINAL
<br />i'tr.r.( d r.nrr'\ li.\
<br />(n""'e/e/t
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