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BUILDING. INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDER DEII'ARATION I n6.ht !flim und6 Darty of poj!,y thd I m cranpt tDh th. Conl[.rot LicfrE Li* fot lhc lolLwinS rd$o (sd 701 I 5 ABin4 &d P.o&.bn Co&): Any Cny or Cou,ry *'hah ,.q1i6 . F lo @iro.t .!8. it'Fort' daDlth ot rqt &i. xnrlE . Fni ro nr islre, .lo rc$iG t {'lktar ror st Fnn lo frL t !iF.d riaEl thi h. u dE i lk66.d F ar.d ro rh. piovirioN oa $. Conlrlcrc! LErrd t w (Ctipls 9. Com .in8 *nh Sdlio. 7O0o of Diviuion I of th. Bwi.d sd PmadhE (1'd.) q lh.l L or ih. n Grnlpr rlE.tom.rd rn. t3i lor rh. aLg.d daF6n Any vhl.lio. of s*1hn '701I 5 bv &v .pplicd foru FUr eF! llE splt&t ro t civi! pauhy of mr mE rhr fir. hor&.d 6ll&! (t 0O) l. s olE ofrhc Fopdly, o. my mptorc *nh wasd E thcir sL omFE lion. sill & llt $qt an E rtulE i3 ml idnd.d or olT6.d 6r rb (58.7044. BcilB Dd ProfdioB cod.: ft. co.tr.dd't ti# l& &6 nor .9ply ro d o*ns of lh.FoFry *ln hrirlh r iglrâ‚¬ E@ tld }ho dc sn @l hirelf or lE*llor lrnoush hL! or ls o*r.npblq Foeld.d rhrr r(h 6Fov.td G ml lroi.d d ofi,ld 6r r.l.. l( lF*w, dE tlildlB d its6-Er b eld dhb m va olconpldha lh. Oftr &iitL will tw. tlE h!&r of Foving $!i lE or tE dil rct hrld o, inqbv. U. FoFrv 6r tlE FIFE of -1. s o*G of rlE p.oFry, s d.lN'rrl, cotuding wnh ttrlE d mnrrloB ro @nfrd E F)al (Sd 70{'l &BB !d Aot&* Cod. Th. Conlr.cror'r l-ic6k Iis do6 ml 4,ply to s owE of FoFry {ho blIdr or inprctB rhd6.. lnd f,ho conh.lr lor luch pr.jer. wnh s Co do(O lic4.d tu6uer lo $. ( oor'lclor! l-i.@ Lr*) I o crmd 'dda Salioo , B & P C. fd Ut 160. D.lG: Ortrq: l4a8f,E8[CgMEdrArq!DISJAAIIq! I lE.tr .oim un& Fo.!y of Fjury oE oltlE folbu'ins dElJ.ri,B I h!v. Erl will tuinr.in i C.niakar. oaconsr ro S.lf-lsurc for $Drlsr comPn tun, s Inviild for by Sdlion 17C!) o f th. l$d C.d., ld th. FfolM. of Oc Nrl lir s$th rlE Fnn b ilru.d I h^r ed *ill d.i rin wo*6r .omFrElio. iBmm.. 6 r.quircd bt sdio. 1700 of tlE Lrbor Cod., for lh. Ffotu. of th. "ort for which lhn p6ni i! isu.d. My worlst cohposnion iouo.. cmi6.,rl lBlicy numba @: wlrl- -l cqtit rh{ in tlE Ffolr1@. of rh. qo,l for *nth rht Fnn i! iqn! I sh.ll nx @ploy ey F$n in uv meE r B ro tidom sbirl to ltE $vrd'mEFBri,n E$ otcrlifom'a .,rt +e lh, irl lllould b<om et.tl lo tl! Krtd' onpqBltio, prDrsioB oas.dion l7O0 ot th. lib.r Coda I ndl fodhwilt snpb $ilh rtFr pmvnhN WARI{IN(;: Failu. to cu. vorkd' @,lpas.li6n covd+. i! uLwful. dd ddl tubidr M mploF lo onintl lsrti6 ud !trrl ah6 up tt om hund rhousd 6 ,8 (llm,0ou).to rh. co3 of .omFMiol sdb. :1076 of rh. tltd Codc ord.! ,nd.ndr,'s IEOISAIIO! I hftb, irEm un& FrXy ol pdlliy rhi I d L.(s.d un& Ftrvti8 or crrFa 9 loffiins $ nh S<tion 7m0) .r Di! ri.n ll of rh. Buind dd Pmft*rioro codc. ond dy lt.M i5 in lull loE. dvl.iI6t o,lt I clllllAJJ(I1alir.Ellllrilcll(I I tmby lmrm undr Fidry o f Fjury rhd lh6. n . connruclion Ending 4fty tur ltc pâ‚¬fomdc. ol th. smt for ltich rhi tEmir i! irru.d (Sc !097. Civ. C ). arrucaxfllctlEarlo! I ha*r lfm rnds pd!h, of Frjury oe of rh. f.llosin8 d.tl4rioc: Dorclirion PmneArlEror Norificar'on F.da.l R.Sularionr ( I itl.40. Pmo) R.q!nd tara of Nolificdir -l co1,ly rhar rhc Ld(al r+ohrtuN Esardms slxstoe rdoval d. tror .pplicabl. xr ths pq<ar 6 (d6 'hr r rE c Ed rhB epr. | -dM !n Srltc Llu ElrrE 16 bui 6. nd cd. fid tlE .to!â‚¬ inlorflu.n n.ofu I .!G ro omtly *nh iI (_nt !d Counr! r.Fed.iy6 of lh6 Cily a.d coumt ro dra uIDn llE ab\.f,dn)nql prcp.ny lor iNp.d ,lppli..nr or Atdl Shnll rr'.-i,".-","(p.irl, X 4)e.ns{c-a/4/,t6 Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Subf loor/VenUl nsulation Roof Sheathing Shear Wall Framing ln sulation/E nerg y Drywall Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req Deputy Final Report Engineer Final Report Flood Zone Certif A FINAL 5-g-t1 x.\Lp0) Certificate of Occupancy {v Notes, Remarks, Etc -, I "rnrn"^o.-LJQ(A _,*^_ oth412_ ",,," /zfr?frtr L)t