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BUILDING. INSPECTOR RECORD SITE.WORK DATE rD/srG.COMMENTS OWNDR BUtt,DER DEL(NiATION t hd.b.rm und6 F tl, olFrury ih. Imn F nom rlE Gnr-!6 ti.r r^ for rh. follouilrr rx.n {Sc 70t I t B$in6r .d Profdhr ('od.): tuv ( ny or Coud, \$kh rdtut6 d Fm nr codrucr. .h6. improve dmlili or rFn 6y srtu.r(., Ft, ro ir! 6udc .!o r.qin6 rh. n pli&r ror ru(h Fnn ro fik . itn<d rd.tEn rhi li or rlr b li.6!.d FneLd lo lh. Frn bioB of llE Co.Eukr'r !t !.d L.q' (Chq,l6 9. ('on'ndins with Scli.n 7000 ot Divirion I of $. Buti6 ud Pmf6irN Cod.) or iha lE o, irE i! .r F rhd.non drr rh. t6i! fir rh.rlL*al nmFion Ant!k!hrh.ofsdion70115b!_uy lpplicsl for r FEil3ubjd! lh. +pli.&l lo rcililp.Ellrolnor m.rc lhe li!. hun&d dollus(1J00) L a ora of rh. FFrt. or ny .oplor6 r'iri u.{6 a rh.n $k comFerion. tr ill & rlE *o( d rlr !r!.le i! m' inrdrdal or olId.d f.r $L {Sâ‚¬.7o1,1. oriB dd kofai'6 (-o& I.lE co R1.a. l.k.e l^,&â‚¬ d q'ply ro u o$E of th. tmFly tr'ho tlikk or imFotq thdstr rxl stn &E Mh $!* him*I, or h@lf or lhreu8h hir or h6 oq mploy6. rovid.d thrl ruch inFolatdle m' -id'd.d d ol&rd 6r slc IL t tr66. rlE tlirdmr tu n+o\qd a sld *ihi..N )d ofotr'pkh( tlE os'B Boibd $ill h!r. dE hrdar oaFr'urs rha h. or !h. dir nor build or ihprnv. rh. F.F!y lor ilE FrF* of l. a osF of rlE t'oF . o crclun.b .odrding *nh licE d.. 1116 ro odM lh. F.j.d ISE 70411. tluli6 anl Aliarih ( od. 'rh. ( ont&ror'. l-ic.ne lis do6 nor lpply nr an orn6 ol rmnGry tr ho build. or i6prov6 rhn@n, &d rho mffirf .wfi rNj.El3 qih. (tiddonr lk.Bd r!6d rorlr (-odr*.r'. Lk.M ln) I ncrdfl u&l(rsdrrn D.r. O'nn .ulBliEaii:(a fflttrQtD!(l.at^IlQ! I h.cbr amfln unns pqulq otrrJu^ oE ofrhâ‚¬ finb\rnr d.Lhrah6 t hrr. ad *ill ruinl.in . C6rrfr.l. o,ColM' ro Sdf-lmr ld $.rla' omFtuion. E FlriLd for by S..lii. !700 otllE L.bor Codc for lh. Ff.trffi. oallE Bo.I lor {hich llE Fmn b i{u.d &H*l;llr;r ,^-.'[)L{ rin sork6 .omr.N.rion iEur.ft.. a Equt.d hvs(ri.n ]?m of th. hhor (nd., for llE Ffom.nc. of pdni' ir isld My sortd onFMs. iBu,m. ffk rn polay nuntE r. &.eztat') nnic) Numr.- ttl cUC bf!4 asl6 --, 3/r/ 2i l.d'f' thi in rh. Fto'mft. olrft. *orl fnr }hahlhrr Fni K Nu.( I rhrll tur dpht rny pn$n in iny mend $ 6 l(' b..oaE sublat to 'hc sortd comll<c.l tr'n l.sa of (-!haomn. Md +.R lhd if I stbod koft rutid lo 'lE . rirlc mmFls'ionIrn\tn 6 ofs.cli.n l70Oof'h.l,b (-od..I stlll.lon iln omply silh I hos pmvisioN WARNIN(; [ailurc lo c@ *ort6J $npilroiion covsi*. it unhs ful. and rhrll lubj.(l d dpt ]s r. aininJ Frri6 eld .nil lin6 ul ro or hundrGl rlFsnd &116 itl(x)-(xro). in sddihn n rh. c.t of co,np.Er'oo. d,nrrd c r ldal io. 'h.s.d(,n nra frrh.l.alin (' DISIAAIIO! I hdcby arfm undq psulry ot Fjury rhll I M hc6!.d und6 Fovirion olch.prq 9 (.onmftins wnh Sc.16. ?Cxxr ) of Ir!i!b. .l ol rh. Rurire ud holdioB Cod., rd my lk.G i! in tull fo,a dn (fl61 '',"",,,,',-B*" t[-tt/tq o,"",",--:.y, c0!gaiJ(I0ur!!Dl!c-AcE!c( I hftt y lmm und6 Fr.ly o, p.rjury lhd llE i! !odddb. Ldi"{ rstry for lh. Ff(tl]lr!re orllE *st tu stah rhi. pdnil. irsu.d (SE loc?.cir ( ). ASTIICAII.IIECI.ASAIION I fidrtl-n arm utol.r Frht of Fjury or oarlE lolbr mB .t(hr!! ins IXmllirbn P@ ! A3tBr6 Noxicdio. lcdoll Rc*uhrionrlT lc40, Pan6) R.rlut.J Idrd ol Ndia.dii.n I !or'lvrharrh.f.,lsalr.g!lartr,ns r+ardtr'g trdErE rdno\ rl rr e n r lptl,.ihl. n,rh'rpru|tt l!(ifyrh lh.\rrrtri rhtr iml'rir 'on el nxr. lh rhei[\c ]trnrnxri'n '\c.r(r I+'at)c.m b *Ih rllCi) rnd (irunr\ y ed (\,unryto nrq o,mn tlFodidN6 dsr.i.ljqrrchrllx Idi.s conrrudrr sn lEllr iurhrrnc r.rr.grniv6 of rhir Cn !b!c nml()ncd pn,!.nv for \rrln.,trr !tr \rttrr:i!tr.,r F ".k/,n rhl q Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Subf loor/VenVl nsulation R oof Sheathing Framing lnsulation/Energy Drywall Ext./lnt. Lath Brown Coat Mason ty Pool Fence T-Bar Handicap Req Deputy Final Report Erlgineer Final Report Flood Zone Certrf. F|NAL qufl/| 7:W.fr- /0y Certificato of Occu pancy Notes, Remarks, Etc. Shear Wall