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SITE-WOBK DATE ID/SIG.COMMENTS OWNER BUII,D'X DEI,CARATION
<br />I krcby darn u.!.r Irulry or Frlnry rhd I m .rcnt rn,m rtr (i6r.Llo Lr.nE L* lor rt rdL,*m8 E&,n (s...?ojr.5
<br />8u!81 trl Pn{.sln Ciik)r Ani C y or (i{dy whrh r.q!E. . Frrnr lo !rr{Ni. .lrd. op.oE. &B,l!t r qxu 6!
<br />ntuturc, F$n' r r.ufr...k' Equr3 rh. q,|'l.rl ntr rNn rEmi n nk r rllmJ {.r.mn h.l lIo, tE E h.nr.J pu.lun
<br />t,lh. p$vh(rnr of rh. Cohlr.cktr s l-Mns.d ,jw (Ch+lcr 9. Cotrm.BmS *trh S ion 7lXlJ nt Oivron .! olth. Burinc$ ind
<br />h'f.r!nn( (ill.) or rhrr lEd.rh. |.!.tr{i rlrrclnn aJri rn h.r. rd rlE .lL8.d .r.n{r $. Any vi{irrion of S&rsn 7011.5 by my
<br />rlltilranr for! Fmn {6r.18 rh. +rlr..r tr.c'v FMlry.f mt frtr. rh.r fiv. huftlBl &rllrr ll5&)
<br />l. rs owm.olrhr phltny, or ny.mpk,rr.s e(h w,!$.r rh.n snc.r,ml'Cnsdn,n. willth r& w,*k,nl rlE (u181i d,
<br />dcnLJ or .ll.dl for qk (Se 7(x.1. Bu.E( ril Pn'f.$r'nr Cd.: flr (i'njraioi r trd( tr! *r. ml +Ply ro u owEr of
<br />rh. F'IEny *hr hodjr,tr lttnE rlrch. .trl *hr 'tE u-.n k* hmrll or t Bllnrrtu ulh hn r h4 o*r.n+hy..r.
<br />pn,v'dal rhrt \xh mF'Em . & n{ d.d.n.r ofla..U fttr qb Il. lrDck. rlI to ihg or uqmErd s oll *ihtr rft Fu
<br />dl u,rpkri'n, rls O*ncr BultLr wJl h!v. rh. hhLn of pn,vh3 rh.l lE o. nr JiJ rr ln l or nrthrvc rh. !tufEny fttr tlE pr4rrs of
<br />L r( os rr ol tlE |F)tEdr, .m .\.lulE ly codr *r ns wnh lKcneJ .odrr.nA h .on{ rud th. F,Fl ( SN 7lx.l. Bunm$
<br />ml t\ i\$rC{xle: l'h.(i,nta.rtr'\ l-'(cns.l.{wJNr nor rpt'ly !, ,tr dwncr ol phtrcnyeh,, ht,l'l\or 'mtovcs rhcrdnr,
<br />rtut vhr odElr(ttr rurh pn'r.h *!h!(id*ro(n lrcned pu^ud h rl* C,'nt*ktr r l-rc.c lr*)
<br />I n.r.nrF uBhr SND.-_. B. n PC ror rhn Er$.
<br />D.le- o*mr
<br />lvoRl(FRq' c(lirPE\saTloN
<br />DECI.AR TION
<br />I tf,rchy,,ltroundcr p(nrhyolFrlnrynn. ol rh. n,lhwnf J.(lurrnn(
<br />-l
<br />h.r rn *rll drrrD r C.nf.d. ol Cotr-d ro S.lt-ltr uE for sxt6 @np.BrEn. a Fovrldr lor tty Se1.n l7m ol E
<br />llEx Col., ror rlE Ff()lrlac ol rE k t rr rh.h rh. Fmn . i$Btl
<br />I hrv. rtr(l w' ll mrfl i fi urr kcrr ( on{'.n\rrkr nFur:h--. r\ cqtrm{l hy S.d (r lTrx) ot rltr I trhor O)'1.. ntr rh. l.rtuI num. ol
<br />rr. *, kn,rhrltrh^r'trxrts"nhl Mrf,,*I.,\ lF,li\ nun$.r rr
<br />,."., '/Jnaria^ 4 d"tf
<br />,,,,,.,n,,,,,*, . 5a?6otS.,-{
<br />-
<br />',.,,,,", I/-l{t
<br />rlorrtutucolrh. *ork n, wh(h rhtr ltrmr 6 r\u.J.l \hrllnor cmpk,y.,hy tE6'n rn
<br />$ r\ t' t\( * {,hlL\r h rh. wo .'. (',mn! \ir[ 1.'w\ ol ( ihl'nn'r,,trrl xlr.c r
<br />sd*cn' ('fltFn\.rn,n F)vRrrn\ o, S(rrm .r 7(lr ol I h. llhtr (irL. I {uU. I
<br />dvd fin.s un h oft hlnlEi rtu,ur.nl dolldn I'lm.(
<br />\L, rntrj rr,76olr|tr l..rlir ( !rl. trtr.'.{ .trkl .iIi'rv
<br />,",5-a141
<br />I &E6y rlnh unj.r FMxy or Jrrlry rh{ I rm lNnal und.r F)vr!. ol Ch.r,rcr I (.o.mc.''n8 w h Sld Dn 7(Xr) ol Drfibn I
<br />ol ih. Bo\mrr:nl Prul.t.r,nr CdL. ln mv l.6r s tr tull toE! rJi.flar
<br />,, ., .c'{@
<br />,,,,,". j€Q-{q c(o a 166
<br />a
<br />CONSTRU('TIONLENDINGAGEN(\'
<br />I lEEty.rrrn un,.t Ful, or Frllry rhi ttEE ( r.snrturi'n Lhlht.s.By f{tr tti Ffl,ljfu or rlE kxt lor Yt.n rh! Ft !
<br />nrkd (S.c. 109?, Civ. C )
<br />l.nJ.r s N.nr
<br />ATIIICANI.TECI.ATAIIAN
<br />I lritfit .iim unLr Ful y of Fr/ry oF ol rh. ro,brr8 dd Ld.n.:
<br />D.mlitDn Pam eAilE{or Ndfrxren F.d.rl R.luhrxrr (Tiktl0, Pzn6)
<br />-R.quiEtl
<br />l.lier ol N nidir
<br />I .cnd, rhlt rh. l.i.r.l rc3uhrlni E3nlm3
<br />eon{ y*{h rllC[y rft] (i,unry
<br />onlD .\ nl Srrr. Lrr^rhi(Ciy.d Counrrb.d( utDn rlr
<br />.tx,E E,rrrEi liorny(
<br />'\nDli(.nl or \!.nl SiEnxl
<br />ah?
<br />Set Backs
<br />Forms/Steeli Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/VenVl nsulation
<br />Roof Shealhing
<br />Shear Wall
<br />Framing
<br />ln su lation/ Ene rqy
<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 Certif .
<br />FINAL zh e /t;,b,t',/a'
<br />Certif icate of Occupancy
<br />Notes, Remarks, Etc.
<br />BUILDING- INSPECTOR RECORD
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