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SITE.WORK DATE ID/SIG.COMMENTS OWNET AUILDET DEL('AIATION
<br />I hcrchy rfinnr u Lr p.BIy,rl F jury rh.r I o.r.trl|la roh rrE Gdr*16 LE.n€ li* fttr ri. linb*ns Er$n (Sd 70.)l5
<br />Blin.s .,rl Phf.si$ Cirl.): ,A., C y or Ctur, whrh aq!ftr ! Fr ro Lrrtr{dd, rlrd, mF.w, .Lm,lih or EFn dy
<br />ntururc. Fitr ll' irr niller. rlh EriuRr rlr .l)llkur ior rkh lrm( r' lilc r nSrd {t.r.trnr rh.t lI or s& i\ lu.trsl Fljfu
<br />16 rh. lnrvsnnr of rh G, frtr'! l-x.n.tl L* (Chrlrd 9. Conmknt wdh Ser$n 7{)(tr ol Drvnion ! ol llE BurEs uJ
<br />Prn.isrnt(rL) rhi lruih. N .rcmnr ttmln'm .nd trE brs* turrE dk3.dcloyrbn AryvirLri,notsdrMT0]lSbysy
<br />{'!lr:d ntr rFm \xhjftk rh. iprl&rnr t, s {v'l p.ulry oi nn fue rhr. riv. hunlrd Jol,&r (!5Oo)
<br />-1.!\o*mrofihclioFnr,itrhyc,qli,!..twih*r8.trir&ts)k$qttrqrion.wll})rh.s*.rnrhc(riF.mrd.n nt '{ olf.Ed fd sh (SE...7(X4, BurE$ r8l PNLsqrni Co].:'alr (tnran,i trdr l:r *f,. n{ rnllylo.n.*Er ol
<br />rh( IhFn, *h,t l nr [{mt!! !trh)( ull wh) &Er sh $trt hmr.li or h.rrll or rtmulh hu o. h.. oln.ftrli,yc.t,
<br />Fovrlql rh.r su.h mF'rcmnh G r{ urlcrlal qortcEr,lir el..l( tnEE,llr hl'tlo3 q itqn'tm,n u y'UwrhDor Fr
<br />ormn rr:rDn. rrr O@r Bu b wU har rhc hd.n o,0nMn! ih, lI,r rlE Jtl d h'! o rirDK irr FbF y lM r,r tt4nEor
<br />l. .r oDrr ol rh. FIEny, m q.lulwly co,rr.Lrn! *rh lr.nkl omdra h lonner rr. F+ar tse 7{)44. alsms.
<br />rd Ar,i.!t.n C(xlc,Ih. c(lmr-tur'! l-i.nk l:* &{! mr {rfly ro so*E.rpNlEny wrD burldi or mpreEs lhcro,n.
<br />itul who con'tur ror seh F,Fltr * h. Olll*lt)nr)|ft.€n,rl\u' roilEo'ilretx\ llrns 1.,)
<br />l.m.\.mfl uRl.r S.(ri)n .lt.l P(' !,trrhtr (.q'n
<br />WOr(Elsffi
<br />DECIAf,AIIO!
<br />I h.r.hy lalrm unJcr FuLyol rsjut.E ofrh. tult'*i.s tL.l',rri).t:
<br />_l hale lDl *,lltunr1m k,rI.F' .ohlxit.ri,n in.![Nr, r\ Fqu6l hy S&r6n ]rdr ol r h. lihtr ('oJc. nx rh. l.rlomElN of
<br />rh. work for rhrh rhr lErnd n sqhl. My w(*t6 6n{End sh n.rre c cerr .rn FnEy nuatrr e
<br />94303\s-7 zlr ltr
<br />sdlr'n .10?6 0l rh. L.trtr (ir.L, hrcrc( ad riromy "ir.t<- u \:-G
<br />ItcENtlLlrNltarlga
<br />DECUAAIION
<br />I rEEhy.lrtn un lcr FMlyol F jury thi I.f, ll(cnr'l unlcr |n)vsi,nofch4r.r 0 (conmrh3 * h Sdrar TOxl) ut DN[rr I
<br />ot rlx Burd$ d1 Pblcsbtrs CdL, turl nry lkd< r m lill irc lrl.l1..r.
<br />'3 ZAa
<br />qalGr8uglrNrElDNg-&c!!1f,
<br />I lrEl'y.Iltfl u dFMlyoln ij'lrylh.l rh.E N. drnnru.tr'n Ln ju8 .I.dy nn ih. FnairrllM of rlE wt iir rhrh rhn Ff,. u
<br />lud(Sc 11197,C!v.C )
<br />6TTLII;ANI,.OECI.AEAIII}!
<br />I h...6y,lim u .r FnrI, oa,ErJury oE ol rh. ltrb*rnf dak.tN,nr
<br />t).frrlixn P.mi+Arh.n.r ffti rc.rn. F.dctrl Rc8uhl!'n\ r'fnt,{r. Prn6)
<br />R.quft J l.lr.r.I flrfr.lr-
<br />F'larr \ RErJ'ng r\h.{^i Fnr!rr!. Ei r|lnlrJhh r.rhr nFFrr
<br />Xlrd,l,rh{lhaEftlJrhtrrpllrrrmn]nrr.rh,rrrr3h,vc.nkrturi,nF.ofrrIr3r&t'n,mnly*.rhrllc,rndc,,trnr]onlerci an! SrNrc ljwr fthrrrg (, h!,tlm3 $n{turbh, lrl h.Fby iulhtrrc EF.cir.xv.r oarhr Cay a.J (tr yh cnr( uFnrlE
<br />rhnc nr r)ealpn'p.nyl{n ni\r...on nur[,\r\
<br />Apt,lic{nr.r As.nl Sirn{lur 11.L \-.---sIl'.Y \---t-E-
<br />*,. rl< (rt
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />SubllooriVenVlnsulation
<br />Rool Sheathinq
<br />Shear Wall
<br />Framinq
<br />lns ulation/Energy
<br />D rywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />3-9- /1 xv$d
<br />Certif ic ate ol Occupancy
<br />Remarks
<br />BUILDING- INSPECTOR RECORD
<br />T-Bar
<br />Flood Zone Certif .
<br />FINAL
<br />Notes,Etc.
<br />-llrr.u
<br />*illrornr.o.C.d irrc or (i,n$ t' SclUn{u,c r.tr k'.1(' .r'nFnrd i,r, i Pn'!d.dlnbrs.crr).171l(lolrh.
<br />Iihn Cii.lc. l'tr th. n rlllltrBr ol rlE so li'r *h.h rlE Fmi n irscJ
<br />RA-e-o-t - 1$-s.
<br />-l..n
<br />y rh.l in ilr Frf{lll[! olrlE *o,l lor *trh rhr Fm tr Fsucd. I rhill fl, .qrli,y rny F&,. r rny .mr
<br />r) $ kr tF.r,m ruhFr ro rlr k{td.'d,qxnq! x'n lr*i orcrhtotur, lnd r8R rh,r rl I rbulJ tE od suhjcd n' rrr
<br />*drr.n ($np.Ntrn Fovii$n or Sn'rr .!70) ol rtE trhor C l., I shdl, n'nh*r h (-n
<br />'ly
<br />*rh rtnr pn,vnioN.
<br />WARNING: F.iluE lo G@ uxt6 otr[Emrrir lrrvor. s unh,ful. uu] lttll suhjc.r e.nfl'y.r k' Lmml FEIF.,n
<br />civil 6Er uI l. .E tudEd llFuqd thlls (t1u,,000), D .dd on ro rhc coit of coryrntrDn. drns*.r ar Frvrld ror rtE
<br />t4
<br />lxndo r Addrcs:
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