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DATE ID/SIG:I
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />-
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Roof Sheathinq
<br />Shear Wall
<br />Framinq
<br />lns u lation/E n erg y
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lr/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enoineer Final Report
<br />I I
<br />FINAL rl7 I r?<uqn)
<br />Certiticate of Occupancy I I
<br />Notes, Remarks, Etc.
<br />nurr. Fir ro ir. i.rur. .ho cqunB rl! .r'!li'nr for qh Fmn ro 6l . rilEn lrdc,rEr lh,l lE or {t a litd.d Flt&..
<br />i. $. ti.rilbm 6l E Co rlct Liu$d L.e latupld 9. Coltm*in! *nh s..rb. rqD of Divnhn I or rlE BBim$ rnd
<br />Pmr$sions C.d.) or rtur lr or rlE is .rcn{r rlEEfoft . j rL tEib r.r rlE alk8.n .t.rplion. Any vn .rin ur sdrhn 703 L5 by .n,
<br />lprlic.nt lor ! Frmir sutj.cri rhc rmlklnrrorcivilp.mhyolnotmElhlifivchundrcddoll&t(t5ml
<br />l, .s owEr of rlE FlrFnr. s fty ctrploF.. *ilt rlscr $ lhct $k 6n{Emiirn. ril do tlE *(t rd rlt .naM k mt
<br />iflrci&.! Gofi.Ed fr Ek 1S€.7Or4. BlliBr ed ftof.$ioB Crit TIE Coftxld.i Li.rr Lrw.tB Dr +nly h & o*Er ol
<br />llr Frd, wlb bir{! d i,tnrc dB6^ .ri wrE drB Bi w'r* hilEr or lEElf or rtlougr! his d ls o$ .trploy6.
<br />tmvacn rh.r rEh irrm@trrE E irde dolH fo. rt ll lbw. rtr ttrrBirBd ingolm r$nwrhi.om)4,
<br />or onplri.,^ rtr owE Build.r rio lIE l,E hr&r or Fstua {tr lt d aE dil fl, tliu d i,FN tL Ft'Fry t, 0r FrlIE or
<br />l. r\,rn.rol rh.!n)ndJ_. nncrch!\cly.oittr.rtrir q(h l'.ctrrcd .oM xrt!\ r' d arru.! rll troJ..r {s( 7{!J ltD{nc\\
<br />n llhJlir.i)n(,ntr'Ih.(i rrcntr s l-icrn\r I rw ,l('.\ irpnlyt!r o*id olt'..Dcnytrho huinl'or ntt'r,v.' rhtrc.t.
<br />xn,l *ho mnt \l(tr{rhnnilc(r*[h,(nfir(rrr\r]f,(n\rdltr'nr t)rtu(i rr(ntr \ Lf,ttr\c Li$)
<br />D
<br />.o*.n*, I
<br />OWN[:R BT]ILDEf, DI]T,CA RATION
<br />I d cr.q,r rn)m rtx (inufucr n' I E.n{ ljs nn rh. n,lk,f,,ni .u-niS- rott S
<br />,47J><tq
<br />lrr undcr n ulry of Fr!ry rh,
<br />iB\ .rn Pi.t !.h. ('or|.)r Any Chy o. Cody *hah ,.{uircs r rtd ro 6niM. .trd. i,lioE. &mlilh or EF uy
<br />I !mercnfl und{, s..t[n
<br />l).r. ()NE
<br />norxrr-silolipr.-s,rrtrrr
<br />ulillJlaflor
<br />I h$.br" alilrmlndd F.ulry "l ndjurynm.t rtu n,lL,*rl rlc.Erri(,n\:
<br />I hav. rnd will trDidrr rCcnilicrlcofCon\(nr loScla lNure I{, sortdr'(n,ltl.n\ i.n.!s F)vilcd lbrhyS(ri,)nl7{x).lrh.
<br />lrtltr Cd., for thr FrlornEN.ofth. wo nn *hi(h rh.Isnnr h isskd
<br />I h.v. r.d will Dr.trn *orlcF omlEnqrbn iNurr.- r Eqrr.d by Sdi ro. :l7lD ol rhc L.lnr C.d., t, rlE Frfol]rut of
<br />rtE H,t lc *hich ihir Ff,Ul n ir{.<l Mr rqlm oqffri'n imrrN rss rn tnlty numb.. e
<br />l.cnilvrhrr inrhLp{rtun,Encruf rhcwork tr wh(h lhNFrmil l i\\ud. l\hrllror cmployatry rr\r r xtry 'nrnmt$ !s ro tE om subj.u n' l,E uo si ortrrE,trr L\rol(Jlilonris n ltrrr.r rhrr rll .hrU hL.onrnihjccrn'rlr
<br />t!/7r.
<br />( (lNS I Rtr( l'I(rN LI.NlllNC ,\l:l N{'Y
<br />I hrrhy rtfirm utl.r lt lryrltrrJUrJ_rharrhcr.F|(.n!nrlnnkndin!rlrn.ll(rrltl].nonuN.olrhr\f'ki,t*hrhrhnIsn[t
<br />irrEd rsd Il97 civ (- |
<br />l.nlcr's N.m
<br />-
<br />ATIIIIANLDISJAAIII}U
<br />I h.i$y afim undu r.n,lr, or Frrury oro oflh. nnk'wnr8 dcc!tr.lions
<br />l)tnr)lirion Pctrnik A\h.(or Nor'fi.srion Ii\t rul Rctubrn)ns (Tillc 4ll. l'lrl6)
<br />Rcquird liidnl M ir.ari
<br />I drry lhd rh. LrLnl rcauLl io.s Esrdi.s rrlBftx kmvd n N drlpli.hL lo lti ltDin
<br />I.dni$zt I lEv. Eld lhn.nplt.ri.a ad dtrcrt, lrt.bte infomdir s.onsr I lsr'ooi{,!r*trhtllCiryrnd Cou.iy
<br />odiBmc..nd Srltc t2sr ELrint l(, hlildina connMhn, !n lrEby rurhnir rcnE{nrurivct orthh cnr.nd Cou.lylo cnls uli)n llr
<br />fi,v. nrnrB,nd nn,F.ny itr ir.p,vi"n urF ^q, ,
<br />,rpprrrrnr or rscnrsrlurur./ bfur, /
<br />Pmi,*Em.,pr, ,: /t 67 ',ll ,, ./
<br />SITE-WORK
<br />Subf loor/VenVlnsulation
<br />Flood Zone Certif .wo s orvEtrgrhn pmvi(irnr of S.di6n l7(t,orrh.lrtt Cd..l rldl. aonh*iri otr!)t, *irh rhrc Friri,nr
<br />WARNIiiG: Fnhr b 6uE rd*6'mqEndbn $rms. t unhrrul !n rh.ll ruhF u .trrhF, ro rimiMl FEis ml
<br />c il lifti ull n' oE hudEd rhuend d.ll8 lsllI,]rxl). ifl ddnbn io rtE dn! tl onp.Nrion- {llrr.r .! tmtd.d lor rlE
<br />SNrirn ]076 or rh. Lrhr(id.. hr.d!ndbrt I 16 /7 ,/ -,.,,,/oh|,/ r I ^*Y,WQ,Ahy',.*-| . rr rcFNsi'n foNTtl{lrlx
<br />DESJAAI,I!]!
<br />I hcrcb, sffnm und.' Fdht or Frjury rhrl I.m L.tn€n undc. tmvhion or(.lupts 9l$mmftin8 with Sari,n rfi)) orDivhitn I
<br />of rlE Bu.iEs &d tmlsions Co&. r,n my lk.M n in ruu r.rc si .lf..r
<br />-
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