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SITE.WORK DATE ID/SIG.COMMENTS OWNfI BUILDER DEL('ARAIION
<br />I lE*y .rrm u.da Fqly ol Fjury thd I m .raipt nbs rh. Coi6<r.6' l-t.tr tn tor rlE ft,llowirB r6n (Sa 7oi I 5
<br />&!ilB ..il Prof6bn Co&): Any Cily o, Counly which r.qut6 . F6nn to mBlrucl. .ha. imForq ddmlilh o. q.! oJ:
<br />.IrudE Fi)r ro tr isucc..lo r.q!n6 ln. epli.or lor.u.n,aan ro fik !.sftd ficicn thd rE or i,'. b li.6.d Frnqr
<br />6 dr. Fortiod of lh. Q, r.rq ! l,kald lrw lch!9ld 9. Comc*ins wirh SExon 7000 of Divaion I ot rh. Bu!l6 d
<br />Pmldnnr Cod.) d thd lE tr dE 6 amF tlE.6om .rd lh. bGir aor thc rlkg.d .ra!tio. Ary viohrirnofs.di,n?Oll.5 br..y
<br />@ptuul ror . Fnil subjalr lh. r!?lkot lo . civil p. llyofml morclho fiv. tundr.d dollB 11500).
<br />l, 6 o*c ol[E FotHt, M ny @phr6 wirt *is6 d rh.n ok @mtEadirr, willdo rlr wdi &d {E nnd@ i mr
<br />inoiL<l or o6d<l fd eL (!ia 704.1, BGiB ud Pmf6i.N Cod.: Th. C.drdoi. Li..e Ir* do6.ot rp4ly io m olrc of
<br />th.FDFry *ls hrill! d iqrDrq rhdq ri r b dG kh w.t hielf or h*lfor lhoush hB m h6 oh nphy6,
<br />Fovd.d rh.r uch mFlldEnt e d i drLd or olM br !L. lt trqBq,0r h)ildiE or trrProd6n i htd *.irhii ft,a
<br />ofcotpkiE E (}*ffi Bojllc sill h.E E hlrlnorForiu tnd lEor !h. dil mr hrtdor !rs,.E6. F.Fry tr EF,!o..of
<br />l,6o*Eolln FoFiy. m .rclBiv.ly conh.t r.g *irh lico!.d .oitr..rou ro codruc! tlE Imjcl (Sc 7044. BEil6
<br />rn E!ftsnn Co<i.: ]1k Co.klcroar L'ctu. Llw do6 ml .pply io D orE of propdy who boil{k or inFo\6 rhaon.
<br />&d who onlrrts aor *h Foj.trt qirh r (t r.cron,liccB.d puEomr io rh. codrdor. Lrre Ir$)
<br />I dn.rdp{ und6 Salnrn
<br />l).rr (|ltrer.
<br />]ll]B!i}:&r!l)llfrL:rr()rDl{ l,\&rI rl
<br />Iho.hr.ilir rr J6 thxlrr ol FN\.i.of rh.fdl ln!Jalrrrkn$
<br />I he. dd *rll tuiddr . ( .niaor. olco66 to s.lalBur. f \sl6 Nnpturion- s FoviLd for bySerior 1700 oflh.
<br />tdin Cod., fo, lh. FfolrM. oallt rlrt fd *nth llE panjl i,! is!.d
<br />I hrvc a.d snlnrinllln nortd .omFqrb6 inueq a r.qltcd bt SdFn !700 rlrlE llbor Cod.- fo, th. Ft(tuc. ol
<br />th. *wt lor *nih rhir Fnn u isEd M, {dld odFltion intllrlr. crin rd polt} nunb6 m
<br />I csrit lhlr h thc Ffoffi. of llE sorl t whi.h thn Fnrit s su.d. I !n ll .d @pl6y .ny pq&f, in .ny me.d
<br />e E 16 b<.r ebi6l ro rh. srl6' conp.,ldion h$ of CalilomE &d 4@ rhd ia l rhould bcoft ruu6r ro tlt
<br />$rrtd onFa.ri'n Foyiiioo ol Sd6. l7l)0 of th. tllr ( ode I nElI tonhwith $nply *nh rlF* prcviiirE.
<br />\rARNlltC FnhE io su. worl6 smFMion o!6+€ n unhwtul, Md $rll ebja! d nphF to ai nd Frii. r'd
<br />cnrl fG uD lo oE hutr&.d thousd {k,llsr (lloO,UJo), in ddnion io th. cd of onFMion, dar46 6 Foril.d 6r llE
<br />s<lion 1076otth.l,tFr( ode '.ls6l danoflEysfc 2
<br />ur.!-!.u-!l]_)-:
<br />I lElby rlTm und6 FEhy o aFjlr, thd I m li.d!.d uid.r Foltio. of Cli.Fa 9 (on:lrEfting $th Sdb. 7000) oa Divirion l
<br />of llE BriB.,rl Piofsi.N code d my li.qe n in tull foE an.lr<l
<br />/o'2s:n ,-**.E>;; -/Z
<br />CONS.TRUCTION LENIIII{G AG'^T[A
<br />I hdlby .lfm url.r Frhy of ldiury rhr fid. i r onrru.rion lnding rSocy lor rh. Ffo,rlltr. of rh. *dt ftrr stth rfii Fni ir
<br />isu.n {SG 109r. Cir. C ).
<br />ATIU(AtrLDECUtrAUA!
<br />I hadyrfmu.dqFn,of FjuryoGof rlE follo*irsd.cb.rnd
<br />D.moltio. P@il!'A!b6ror Noril'r.dio6 Fcd6ll R.su l.rio.r (l hl. 40. Par6)
<br />R.quiEd Lar6 of lldi6.i.n
<br />I c6l rt rnd rn. f.d6al r.rrhrioB rcsrdina ah.ros rlfu\.1 ft mr 4rrkabk nr rhis ,ror<r
<br />I cdit rhn I ruv. rcad rh6 rptl@rirn d .l!r. rhn iE .bo\. irtorndion b .otr.ci I !!re ro ondv n ih rll Cil!_ ed Counry
<br />ordin!ft6 md sr.rc lrws Eldla 16 hildios coldnrrio( td lEc6) .ullnriE rqs n6 ollnG (-ir! ard Gu ylodt6 uponrlE
<br />ihr. Im!tr,n61 frrtd) li{'6r.trnn{urp6
<br />";:::;;_",":;L:;iz4u-,,/2'2-S /7
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framinq
<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 />FINAL tl/b/ 20 PKN n-#,H
<br />Certificate of Occu pancy
<br />Notes
<br />BUILDING- INSPECTOR RECORD
<br />"",, ,/o'25-. t?
<br />f-
<br />Flood Zone Certif.
<br />Remarks, Etc.
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