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SITE.WORK DATE rD/srq.COMMENTS OWNER BUILDDR DELCARATION
<br />I hcrcby,flirm undcr p.nrky of pcrjury lhil I ad cx.mpr ri.trr lh. Conu,.ros l-iccns. tiw for rhc lnllowins rcrstr isc..70:11.5
<br />Busincsr aM Por.ssion Cdlc)r Atry Cily or Coutrry which rcqtrir.s ^
<br />pcrnir t' .onsocr, rlrcr. im!rov.. dcmlhh or rcp{n ntry
<br />nructurc. prnrh ns truatrcc.akorcquncslhcamlic.trrrorsu.hFflnirrofilcrsiErcdst{rcmnt Ih lror shc h liccn:cd pu,$anl _
<br />ro rh. lrt)lisioN ofdr C.nt!.ttr\ Li.en\cd tj* (Chrprcr g. Cohncncin! sirh S.crion 7000 or Divnion I ofrhc Busnr$ Jnd
<br />PmL$ionscodc)orrhalhcorshciscxcnuthcrclmnnndrh.bisislorrhcallqedexcmption.AnyvioltrtionofS.rrionT0.ll5hrany
<br />,JtJ:li!nrft{Jr{,mrr.uhrRhhcEpt[.rnrrndcnilncnJlr)Jin.tr1{cr\anfiLchundreJd',lld.rs:ftr'
<br />l-4$ .wmr or rhc lop.ny. or n', c rployNi w(h qJgcs ,r rh.k blc smpcnerion. Nill do rhc w* and ltr srBl@ n ml
<br />irlcrdl{ "r oftscd ro' sh rS( 7u44. Buercs ond PrnE$io$ Codc Thc Conrrmtn \ Liccnsc I:w dods noi,rpry k' rn.wn.ror
<br />rhlfih$y sh, bu,td\ or rmnrn(\ rh.Mtr. at trhu LIts su$ *\r* hinsrllor hci\cllor rhmugh his or h.r oun.'nploycc\.
<br />,rovidcd rhd iuch impn)vcmntsmmr i c.d.d o6.dd fitrslc ll hoNcw. rhc hoiklirg or inrl,mrcnrnl hsldwirhinom )ru
<br />ofcomphrioo.lncOwncrDuildcrwillhnvclhebudcnolFovinglh hcor shc diJ nor huild or inllnle rhc pnpdr, fr, rhd !urh{or
<br />l. r!.sncrolrhc pmIcny. !mcrclusivclyconkacri,U wirI ii.cns.d cotrrrcn)N t, co nrud rhc t,n,jc.r rSc. 70,14,llu\ir'u{
<br />trd Rdc$a Codc:ThcContd.tnsLi.ctrscLa!d.cs..rrpplyk)in (tr.rolnnFny*h,, tuildsor nnpmlcsrhcr..tr.
<br />rid qho onrmcrs fin skh !(I..r\ sirh r Conrnctrr\ ) li.rn\c.l Nrsun n) rhc (lnnru.tr's ljccnr tiw )
<br />I h.rchj- ffiflnunJrrp!nalryotpcrjuryoncof rtu,alnrsingd..hr ri{,n\:
<br />lluvcrklwill'nainrrirxCdnilic colCon\c r'Sclllnsrrii,r*.rkd6.oi!*n\riotr.nqlrovidcrlforbyScdio:17{noidr.
<br />l-ab{trCodc, turihcpcrfonmn...frhceorltorwhi.hihcpd rir isi\\d.d
<br />-lholcandwillnrainhnr"rrlc(comlt.nsrtn,ninsurincc.asEqliE'dbyScction3?00oflhcljborG'de.rurhcnlfonMncolthc wor* ftr which this pcmit is isucd My qorkcrr co,npcnsarion insurancc crnicr and policy numhcr uc:
<br />l'oli(yNu rlrr: I:xptc\
<br />ful Orr, '*, , '* *r,,rtun.c orihc rn,l ntr trhf,h rhh rE,n,ir is hsu.d. I shru ndr cnptoy any,r^on in.ny manB
<br />{ h: tngrom \ubF.r ru rhc *ork6'' r,mFn\JrDn lnwt orc.liromi,, aftl agN rhd ill sh,uld lEcom ubjcd k, rh.
<br />"o\rl c,.mp.n.dn,r l.Fq'..tr, JrS.\r'ntr ,,uu uirh( Ljh( Corlc. I $,11. I'rhtrirh annrl) wrrl- rh { pns'.ns
<br />WARIING. Frlur. t, wurc worlcF !u r!rn\. 'o $vcmec is utrlnwrul- lnd shall $rhjlsi !n crplortr ro dimintrl liMhas akl
<br />civil lincs ut io oR hundrcd lhousand dollus (SI0o.uxJ). in lddilion Io rh. cosr of.omFn\urn,n, d,nu8.s as Pmvidcd for rhc
<br />n 3076 oi Ihc Libot Codc. i cresr and ltlnncy s lccs q.
<br />t)[( t,,\R\1ftrN
<br />I hcrcby lillnn under ranalryol Frjtrry rh,r I rh lianrn ondcr In vi\ion oiChrtrcr 9 (c.m'ftncnrg wnh selion ?000) ofDivhion l
<br />.i rhc Busincss md PrcltsiorsC()nc. and myliccnse n in,ull aoEc oDd catecl
<br />IjANSIf,IJCIIAN.LEIIIINCICINC,I
<br />l hcrby rffirmrnd.r FnDlry.lr.rjuryrhd lhc..isa.onsrflcrion kndinB08cncr Lrlhc pcrl'ormncc otrh.$o f(r which rhi\ ltmir is
<br />k\kd rsec lm?. Civ C r
<br />A}ILICANLI}ECLABAIIO!
<br />I he$y dlld undcr pcnrlryofpdjurt otrc ofthc rollowing d..lrrrn,ns:
<br />Llcmlirnrn Pcrmils AslEsros Norificorjni Fedcral Rcsulurions ('Iirle4l), Pln6)
<br />-Rcqntcd
<br />Lctlcr ot Nolification
<br />L.d,l hJr rl.. l,.J.tul ftgrlJr '.N rp.rJtrre r\tr('( r flrlr. nor.'mlrJhlc t. rhn Imr\t
<br />h&n, 't' , t* ,*,
<br />'nn
<br />;r",". ;, '," ,", *" "h've innn*rn,i h cod.c, I aFd b.onDry wi,h arr ciry lnd counry\"d,{g5}. una Srnr" t"".*lurinE h hu'ld'nB.onnrucri.n- ajd hcrcl,yourlrniz€rcpErm,riv.sorrhisCity d Couoly lo cnrq uFn lhc
<br />,dly tu nrtErior fu4rxcs
<br />Set Backs 7"21-t{y.tt{t)
<br />Forms/Steel/Holdowns z-21- /(,Y.LN
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />SubllooriVenVl nsu lation
<br />Bqof Sheathins Pr^i-/^
<br />Shear Wall k,Wld
<br />Framing I
<br />lnsu lation/Energy u\--l z,--\
<br />Drywall x-v r'l\)\0.!t'-lt r \u
<br />Ext.i lnt. Lath
<br />Brown Coat 4 l-r0.-B J;I ar)
<br />Massrry SctA-1a ?-rr-(8 -lJa${@
<br />Pool Fence
<br />Handic ap Req
<br />Deputy Final Report
<br />Engineer Final Report \
<br />FINAL ?D"Sxlor './h
<br />Certificate of Occu pancy
<br />V-2-'.n-.^-0
<br />Cb4 fu / //fl
<br />BUILDING- INSPECTOR RECOBD
<br />Liansc Cla$:-Liccns Nudb.r:
<br />-
<br />Der.'- Contreclor
<br />-
<br />z?r)
<br />!"111 *llt mPgelil w
<br />T-Bar
<br />Flood Zone Certif .
<br />Notes, Remarks, Etc.
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