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BUILDING- INSPECTOR RECORD <br />DATE ID/SIG.OWNFI BUILDER I'ELCARATION <br />I h.rcby rrr"n utulc. Fnrlly or pcrrlr, rhar I d.r.nu rn,m rhc Cinri..bF' l-f,cne tlw rn lh. blb*o3 6rqrn (S&.7oll.l <br />Buu.s .,n Pnn-s,n Crk) Any c y o. Cou.ry whih r.quK r Ftu h conrBr. .hd. itrl,ok. d.mhrh or (nu v <br />sro.rurc. rxnt' s 6\utrm., lho Equrcs rlE ildrd ntr irh Fmn t, fiLr nsFi {d.m.' rh,r h.or t& E lr.nral PUrud <br />t' rh. I'[vRrni oa tlr Conraltr'r t rcn<r.t llw (Ch{'rq 0, Co.fttuin8 *(h Sertrr 7(x[ or I vBn. I oI th. Buqrs rd <br />Pn.sirnrCixlc)drhlh.orih.N.r.n{ rh...ii{'m {rl rh.6tn\ l!tr!h. rt LS.J .r.tril krn Aryvi'ltrnnolS<rih7O.ll lhrd, <br />aptl'rdr t', r Frmr {!hF.h lh. rflrl'.mr n, r civ,l ll.Mlry dr ftn B'rc rh{ fiv. hu.dt d dorl,r (S5N r. <br />L cs o*rr 01 rh. ,n,Fdy. or my cn[l',]cs *irfi wry6 .r rh.e {,h contcnsdlrr, * l Jo rtI kn* !,I] llE rtdlE !r to <br />lr.nrd or [.r.d fix qL lse 70.1,{. Blsftrl rnJ Piof-rrft (in : I,E GJdh-t, ! trtN ll* &F , .Oilv ro u ovE of <br />rh. lFTrny *ht! jr or !,lIn'6 rh.c)n. rd wlx' 6 *h s)* hm$|, or ls*ltor rtm{lh hF or lrr om crglkryer. <br />ptuvd.n rh.l reh u{n'Eftd! e n hrcnidl orotuE! ftr sk ll. bkEr. rtu ula or rtnxm nsr!*irhi.ItrF- <br />of(uipbu^ rlr owF Burllcr *dln.F rh llnln ol F!v,E td lrrir& ']rl d{ ho lr uqnE ur tFpd, ft, rtr FrIDt of <br />wotKERs'coalPmsaaloN <br />I lE.by .lfm unrt r D.r!, ot F,t ,,r .* ,,f ,L t lr,*.r IAB <br />I h:E ,n wrll Bhru . C.nu rer. or Cun(m kr ScllltriuE nn k .d'$n{Ersar$n, as FovrjGl ror bySdrlr l?(() ol rlt <br />L.trn Oi.. ld rlr pdlm! of rh. **t |,f, *n:h rh. Fmr n n<Erl <br />[{ t*., *r,*.,.. *,r.n's rtEtrur.n nrur.B!. s E{utr h, serM }ru) orrlE l:ho. CirL. ror rrr Frrolls. ol <br />rh. h* lttr *hrh rhs Fmr '! lirhl. My *trt6' dtrrtHqrEn 'ltr*t laH rnj FL'y numb.r e' <br />,,,", AWVY iUrq z.wtcr+ <br />( _<D Ll,ol3 <br />I c.d'lyrhlr rrhc nrrlolNrr.ol rlr w.rk (,tr*h.hrhr Frm r FrkJ I ltulln.r rhpk,v lnv F dn tn:n, Enr*r <br />qr :\b h.(otu lubFr h rlE *)d6'$flqrnurx,t Lf,(or ('.1r1.,.!. ul r€N rh:r d I \h'u! h.tor rthrtr !, rh. <br />workrri (n{En\!r In)vFtr'tr\ofScdur l7fiirl rlE ljhtrC,rh.I tll.ll, f,dhw h (rnply * r(h rbt Frvtri'ns <br />. s mL*rul. &l 2I \lhjdr .. .n{'hF l. sillNl Jt lF t lj <br />(x,.rxx)). n d,litrm r, rlr.n\r ol lnnlrn\ krt, <br />S.rr0n.\07(ol rh. LrhtrC(rL nrcr.{ rnJ <br />','- ll tvl z,,tz-o <br />Ih.Nby rirm uft]c, Fnnry or FJUry rh.l I m lEnkn uni.r Ftvi(;n.r ( h.Prd I (!r,ltm r.8 w(h Sal bn 70q)) 'r ncriln I <br />of rh. Brift( mtl Pn,fcs!'hr Cul.. lrl fly l.oE ! h tull itr.. rn lrlcr q7i7<a <br />o <br />APPLIC NT DECI.AXATTON <br />I ho*t .lim ulLr FrX, ol F.lury od ol rh. toll,*rt &rkEl rr.!: <br />Dcfrni0n Pcrmr+ArlE{os Not i.rln,n Fol.El R.aol,r[nr (T[l.,lo, P.n6) <br />-R.quEl <br />lrrr.rorMrf.lrrr <br />-l <br />.d rr, rh, lh. t rkrl Ellhrrunr Es{d68 r'lr{or rcfr)rrl sc r* .{lllrhL lo lh! tn)i.tl <br />&trd,lrrh.r I h'v. rcr,i rhN rn'l.rfuD tn ndc rhr rlE.h,vc I rsd homtlrwnh.llCiryml (i,dnry <br />tr'vdol rhtrC(y.r (i)unrr r! cnrd !F!.ilrohlfrBrr .,rr Sl.rc L*t rEr 18 tr on(ur nr rDl h.r.n, rurh, u. r <br />/\ppliestrl or Ag.nl Si*,xlore I lr,, h"r-o <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/VenVl nsulation <br />Rool Sheathinq <br />Framing <br />lnsulation/Energy <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 />Enqineer Final Report <br />Flood Zone Certif . <br />I <br />FINAL tt2>G fuA d4) <br />Certiticate ot Occu a <br />Notes, Remarks, Etc. <br />COMMENTSSITE.WORK <br />Shear Wall <br />-1, <br />B o*Er ol rh. F{.riy, rm.r.turrcly.onl*r h! wnh l*nGl sdrf,1s n, LatrrBr rh. F)j.i' (sa 7044, Bur6 <br />rit EuhtuC(t.l: Th. C.ni ror'! Li..nr! hv d.E! ml .rnly l,r t orffi orroF.ty slp bui!'or inporc! tlE on. <br />tnd *b odrk rr ruh Fojcti tnh. Cro'rErdli, trnrJ P{Fulr k rlrco,{ar 'rLEnrL.sr. <br />lrm.r.hd unt rs.ar-n .a ltPC ttrrhrrrg <br />D.r. <br />- <br />oxrr <br />- <br />,nn ". lt I t l2-ozo <br />c fin.t up n' otu h0tulEd tlr)usud &,lls <br />coNsTRllL"TloN I tsltDlNc aclNcl <br />I &rhy .l ll m !nL. IEn.lry .l n rjury rh{ rlEi. r . n'.{nEr,n LnJhS 13cmy L. rh. Frfomm. or rh. uolt lbr *hi.h rhn Fmi( s <br />8r!.J tsd 1097, Crv C.). <br />ktulcar Numcr <br />-xlr,re f,trrr,'c,, t'!)Itnv ntr