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SITE-WORK DATE ID/SIG.COMMENTS O14NER AUILDER DELCARATION
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<br />rpph{nl ix . rEmr !u6rc(ts r,E .rtnli.lnr r, r crvrl p.h,hy or n.r fr)rc lhrn fiv. hu jrd dollsr (t5Ul).
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<br />of cor.9LrM.lh. owE BultLr w hrvc l$ huni.notttovinS rhlr lror sne Jil n,r built u i,th,* lhc ,,qsi, nl, E tlorFEoI
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<br />f-d. *r a* *h-h rh" -^ tr \{El Mv worrdr'!r,.ftM$n nrulm. luH.,n mllr nunhr E:'l*, FalLs Lr.Kc F*q.c AdD t*UOdlV Co '
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<br />WARNNC: [idorc k' $curc workc6 comFns.rlD ctrvcrutc r utrlawt!|. cft] firll srbicr 3n cnploy.t k' dturl lErkrs rtul
<br />.r'l li..r uf n, om hundrcJ thnrund dolh (llUi,U)O), itr rdl irn h rh. ro{ ol comJrtrr.rxr. ile8.t s rntvid.J ntr lh.
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<br />DICISXAIIAN
<br />I h.rb, .frim ldld Fn tyorFrurylh.l I.m lEtrr,l ud.r Ih'vRDn o(Clutrd 9 (rllmLm8 !(h Sa','n ,frxr) of D,vBnr.i
<br />ol rh. Bu.m'r .i.l Prutcs$nr Ci!c, nrl my lrc.r B i, tull frrlt in .fis..r
<br />{'l oz'{18S
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<br />4N;;
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<br />r I h"Yc ro,i rhFrnllf,rlx r (rrtrrh,v.'n,,nmr$nNoBl lr8r.roNtr{ y*nhrUCnrr.dG'unry
<br />Srrrc lf,ws rclrury r') huiltrU !,
<br />rh'!. rnrtr)ntd tollny I'tr trlslr(rkr purF)
<br />$r"*-, - n,-,,n-*
<br />I n mrile ninr rrrinlr
<br />a h.r.lry dlhtrn rcF.s.trr.tr.r.II
<br />-:,EH ru-"
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/l nsu lation
<br />Roof Sheathinq
<br />Framinq Lolzthtt DkYel
<br />lnsulation/Eneroy /c/"rfu.o hn +w',
<br />DrywalL /r / /rz /z zbtu ,Z)
<br />Ex(7lntlLath /lL/D<2 4*az
<br />Brotd Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />/a\\
<br />FINAL FE-zl .hJ*:t)
<br />Certif icate ot Occu anc
<br />Notes, Remarks, Etc.
<br />BUILDING- INSPECTOR RECORD
<br />Shear Wall
<br />Flood Zone Certif .
<br />AIILICABLIIETIIXAIIO!
<br />I hdt{'y .trm utrlr Full y of lxrlllr, od oI UE trlowinf &{h..rrrrl
<br />t)tml{.. P.rmreArb.ror Ndlr..l$n Folcr.l R.flLlDtrrlT L,lr), Prn6l
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