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BUILDING- INSPECTOR RECOHD
<br />SITE.WORK ID/SIG.COMMENTS OWNEN A! ,DER DiII'ARATION
<br />I hEby llfm unjct Frny or Ftr, dd I D .r.nfi ltos ih. cdd6 l*E llv for E follo*tE asn {Sc.7oll.t
<br />aBi6r rrn Ptofari C.d.l: /\., cn, or Cddy ghrh Eqliu . Frri ro onrnnl. rxr. inpm*. d.mlia o cF ay
<br />,lllfu,FxtoiB il@- r&o Eq.6 rlr +plid tu utFm, to 6Lr lllrd nraEr rhd h.d IE i, [.osi ,l!'d
<br />ro rlE lhykiod oI rll Cont-roli l-i..ar.d t * lcl$r.r L Commrcin! *nh Sdi.n ,(m d Divti.h I orlll BBiEs md
<br />Prcf.sios C.d.) d rhi lE s sh. n .r.npl rh...non .nd rlE bsn tor rtl rlLS.d .x.mFi,n, Aly titlrbn of Sarbr 703 LI by ay
<br />.ppri.d ro. i p.m ,!bFu ttl .!?rk. ro ! .ivil p.Mlry ol mr mr. rhr fiv. hudEn d6[b (t5m)
<br />!1. r .vE orth. Fr.ny. r my.nplnF6 dfi xrt r ! rhn d. otrp.dhn, will d. lrr Rrt rn dE llllc r d
<br />idarlal or orlsd fa {h (5€.70,r,r, BurilE rd Pr.asioB Cod.r Tllc codtud t Ir{. t r dEr d pply ro u ow of
<br />rh. ptrFd, *t$ boilitr or iqrcB il6a lrl who dB rEh uxt hin!.lt or lE&lf or rt@ullt h! or hd 6m.nplot*!,
<br />,rcvi&d ltrlr(n 6e.oErnr & m i!r.d.d 66lr.rd fo! sL. lt t ks. tlE hilul d itr!(Efr it&Bvihhtr F&
<br />ofol9triatrOv Buirh *iX Mr tE tuda ofFDy4 lhr lE r|ldildhlllringw r F.Fry ,or ltE Frru.6a
<br />l, ,r o*Er .a rhc ro0.n, !m .rclu{r.ly .onk!.r 'n! r n h l&nEJ rodrn.bn (, Nnirud rl. In)1..r (S... ?Ol,l. Bu\iE*
<br />Jut,tor!\* C.dc Th. (in ncrn t l.ic.n\. LwJ,xs ft rm l, r, itr.*'kr ol p(,Fn y qlt' bu1ld1 .r rmpoy.\ rh.r.on.
<br />!d vh) coda! aq ruch F0FB *nh r co fthnn l..Fr!@ ro rtE c(dldn ! Ir.M f.*)
<br />I Mr.r.m unkI sd
<br />oEgiaarlq!
<br />I h.rby .IUrm und.r |lMIy of tEiry oE Df rh. fo[.*ut ddldr]6
<br />_lluv.ur*illNi nn r C.niaur. o, CoB.nr to S.ltltulE for wo^flj Nrr.Ndi)n, .! Flvri.d f.n by SdtEn l7m of lh.
<br />tllu (j*k, ror rh. tsLrffi. of rlE l..l tm rhth rh nsmir i{ i1!u.d
<br />-l
<br />hlE ..rl will Ni u qrt6 @n{.6nion iNuru., s EqniEd t, SdriM l7u) o(rlE lrbor Co<h, la ll! FfiilE oa
<br />rlr *dl tu *hIh rh! Frd ! isrd. My *rt6 $qEdirn Butrc ons rn l[li, trlfi r'
<br />I.cnily rh.t inrh.FformEof fi. wo f6 wnrh lhu Frnii i! !ru.d,I sh.I *n cn+tty ytEsnrMytll.m
<br />n6t lE rru iuhj.d h rhc mrkcE onlpcMrion L*! oa Crlifomir ril rle rhlr if I ltnlld b.sm ahFcr ro rh.
<br />krl6 onrnc.*t$n IovirDE ol SRlio. 17@ of rh. trh)r cod.. I !ull. fonh*irh Nnply wirh rlE pDwbB.
<br />W mING FTituE ro r@ *rkda .rtEMb..oEn3.
<br />.ivil fiftt uD to oE honlEd rhouqtld d.lh6lll(n.urr). D
<br />Satlr 1176 ortlE tlhr ( (rj., i ftr.nl,r(ftyir*r
<br />Lll !!bF o aplor, ro sirEi IEurE.rn
<br />ol ci'V.Mrion. drrt .r a F.vtd.d r4 rll
<br />I h*by .lrrm u.td.. p.Bty.l Firy rhd I E lf,lEn unrtr Fviri.. ol oqra 9 (6'mEilla dh Sdih 7lI[) 6f Dl\ilh I
<br />of dr Burm.! ..d PDfdirs CdL, rrld my lirde n r tull loc !n (lld
<br />Drl.,- Cddor
<br />coBm!cl&!..Lt!!l!c.Ac[!cr
<br />I rEby .trm u!&r Fu!, or Fir, ihr t4 i r oNrdd LBl,t {4y ror rlE Ftro ollh. urcd tu stit rnil Fni ir
<br />ir$.d rs€ !rr97. c,v c l.
<br />AITIICAIIDECIJSAIIOB
<br />I hdltt .fm nLr Frty of pstrry oE of t& foll,rrt &(!.d ionr
<br />D.tuliri.n P.mirsArb. or NdifE.tp. !.d.nl R.tulito.! (Tnh.l0, P!n6)
<br />_Rqurd tdta of tld,fuln
<br />_l .dB lhd rlE f.d..rl EluE hB E ,$n! .d6rs mrrl E ri +t,i$L ro ihii FoFr.
<br />_l caify rhr I Mrc Frl rhii rD?la.rion.ti $r. tlE ihv. inlomurion i.@Gr.I 186ro6ftp1, wirh ill ciryril Counry
<br />ohliutu.i Srrr.ll*!ELrd3roboruinl Ep.lddrB of rhn c!, rid counr, ro .dd upon rtr
<br />.tir rdr,EJ t,$tEdy tr BFdin
<br />{pDli.rnl or Affnt Sisurun ,J a/s/aa
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/VenVlnsulation
<br />Roof Shealhing
<br />Shear Wall
<br />Framing
<br />ln s u lation/Ene roy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />N/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Cerlif.
<br />FINAL c-vA-%X-',lJ-)i\
<br />Cerliticate of Occu nc
<br />Noles, Remarks, Etc.
<br />Bev. tl8-07-2015
<br />DATE
<br />""'* u/o/n
<br />L.r*ir A,l 116-
<br />Erection Pads
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