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SITE-WORK DATE ID/SIG.COMMENTS <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/VenUl nsulation <br />Roof Sheathing <br />Shear Wall <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 />Engineer Final Report <br />Flood Zone Certif. <br />FINAL <br />Certificate of Occu pancy <br />Notes, Remarks, Elc. <br />,-r*.1 <br />OWNER BUILDEN DEITARATION <br />ond, Fuxy of Fjury rhd I fr crantlr &on rh. Codrdm- Lt@ t w tor dE folloein, ren (Sc Toll 5 <br />Pmf6ior Cod.) Any Cn, or Coui, *hi<h EqliB . Fnn lo olErud. .ns. imFov.. dotulBh or qtn 6) <br />bh! isll,E. rlo Eqlln6 rh. nplk lor !*h Fnn h nL.3ier.d rnGld <br />'hd <br />lror JE it lt.tE d poltd <br />of dE Co'nrdo.! Lica!.d L.* Iclupr6 9. CoEm*ins u nh Sdir. 7000 .f Dir i.b. I .f rh. B6ir6 .r<l <br />Co&) o. rhd lE or rlE i! d@F rhd!6om.nd rh. t 6ir for rlE .l4cn d.nprion A.t \ hldion o, Sdi'. 70:t I 5 by ry <br />! Itmil rubkds th. .Dplic&' lo . c'ril n Mlt, of .or mrc 'hs fiE hutd..d &Um I til)o) <br />of rh. F!I6y. or mr arlolc tr nh *+6 .r rh.ir xrL conFMion. $ill do rlE q o.I dn rlE r ls. it Fr <br />0il6r{ for sL {Sa 7(x4, Bai.d md ltofdhN (od.: fi. Co r*ltr.' l,ic@ l.s {to6 ml4p]y ro dr osffi of <br />*ho hliti or ir'Ircvd rlEei. !r<l sL (h6 {ch sd hiMlf or h@lf or rhNlEh hn o, hd o$. dphr"6. <br />tuch inF!\ ffir! @ mr i adcl or 0rT6.l nn $k l( h.tr o6. rh. boildiry n unrr.L .ftnr i! $ld tr irh'n onc )r <br />0. ()*6 Build.r $ill h.v. <br />'h. <br />hn&. oaF.rins rhd h. o. sh. did mr hrild or imFov. ft. pmFlr tu rh. ntrBE oa <br />of thc Fopgrx d cxcluilcly co.rE.'rin* silh li.s.d conrricroB ro oBrocr rhc Fojd ( s( 701.1. Iruirdi <br />cod. Th. Conlrclolt Lic.nE l,.s do6 mr .mly t..n o$n6 olprop.ny*ho buil.lr or inpro\d rh6Fn- <br />codDdrfq suchFj<r! snh. (bnrEdonil lt.ts d F drolh.co.lrdoirtic@lA) <br />ltl)Ia!8gllllEllAllQ[ <br />DI(IJAAI]OX <br />unrLr Fmn, ol Fjlry oR of rh. tolhs !U &.ld.rio6 <br />$'llm.mlrina(d'ticar.of(,)trr () S.li lru'. fttr sort6' ..nqffirio.. s lro\dal htr h\ S(r(!! r1(x).lrh. <br />fo. rh. pafolrrltrc of tlE r dt ror shi.n llE Fml u ntu.d <br />*illmri rin *0116 compcNliion in!ur.n.., r r.gun.n bv Sdion 1700 of lh. l,hr ( i!d.. tu lh. I,sn,mdc ol <br />whkh rha Fmir i. isucd M, worlcr' .omFcdn,n iNurdc. caEi6 ard policy numhs E <br />{hsl{Lff g L1 a Ld B23o q/ts//'t <br />rhd in rh. pdfotrrlec of rb. so,l for which rhn p.rmi i! nlucd- l ihlll @r.rrhy an! F$n in.nl Dlntrd <br />m. 3ubj.!t to th. *bdrd .omFs irn Lq. ol ( .lilom!. ed rye rnd if I $oukl t .oft rubat lo rll <br />FDvnhB oasdi,n l7m of rh. l,t r co&. I dEll. fonnrnh mnpl)-' *'nh lho* FortFtuFjle lo suc N*6' comFsrM (n6.*. n unLwtul. and 3h!rl 3ubi{ m d tu .mml ,Estb ai <br />up lo oE fiur&.d rhodnd dolhR (tl00.lx[))d,m,g6 a Fol i(H for <br />'lE.f rh. l,tnr Coda inrdd rd db,rh i <br />lE&ltSarlax <br />utula Foliy of Fiury rhd I m li.aE d lnnd Fovilion of(-llipq 9 tcomMins $ilh Sdhn 7firo)nf I)n iiot l <br />od PDlNiod Codr. rnd ny licdr Lr m fuU rorc. Fd.fid <br />t, B, r/o, c t <br />-1/t4 <br />q,s q t7.gA<tr[M;i] <br />(otira!c-ua!-!l:!Dl!GAc[!cr <br />u.d.r Fdry of Fju.y rhd rlE. ir . .odncli,. ldiing +dcy aor th. FfollMc ot !h. *.rl hr s hd rha Fni . <br />Alflt(Axl[t(llxallal <br />unddFnahyotFlua on olrhc tollotrms d.rld ione <br />P6mir. A3bd6Noti6.dio. F.dnrl Rqrlb! irtu tTrl. ,10, Pei6) <br />illallh.IeJralrqulalhnsrc!:ntl'nSr\lr\lr1'.nr\r1 ,. orilnl'crll.urhisI'od <br />I rlra ro smpl, \rih ill( ily itrd ( ounty <br />6F.sbn6.athi! ( ir <br />;iI ra-21' <br />e/t/a- <br />BUILDING- INSPECTOR CORD <br />4