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BUILDING. INSPECTOR RECORD SITE-WORK DATE ID/SIG.COMMENTS OWNER BUILDER DEL('ARATION I hqlB .llm u& Fdly or Frur)' lhi I a d.hpi frnm llE Co do6 Li.G lrs for tlE folloqins r..*i (Sr.7011.5 AuinB .d ftofdbr Cod.) Any Cily or Coudy $fiich Equn6 ! Fni lo oldrucl. .hs. inFor'.. &rtulBh or i.F, Ey ntudueFiorloil' isueq rbo cqui6 th. lp?licst for ruch Ftnil ro frh. iiercd r ffil rh ltorJrilic.i!.d pmflr ro lh. FlririoE ot llE Co rxlor! Li.6!.d L.* ((n.F6 0. ( offii.8 s,nh sdhr ?lll) olOrithn t otllE Eutir !d PDtd66 Co<!.) or thd lE or rhc b ampr rna.ton d th. b6a lo. rh. .llclal .ratr,lio. A.ttoh|b.ofs.dnn7011tbyD, lpplicant for . psnil rubj*t! lh. +[lic.nl lo ! civil porliy or nor mor. the fiv. hlndr.d dollm (1500). _1. 6 orc of rL FDFry. d fty dph)6 * nh $'rs6 B fi.n nk $nF6d ion. tri! (h rlE n dt !i {E rur@ i! d i al&d molra.d fr sL lsc.?o{4, aliixsmd Pr.l ioE Cod.: Tn codr.doi! Lkar lr* rh6 mr edr ro e osE ol th.prDFry wl[ buil&or ir{n\6 tn.6tr !dvtn dEech *! hiro.lf or t*lf or ltmurh his r hs on n coplor6. provid.d rhd $.i imFtrrqer.d d nqn dqotu turl. lr, br-s. i tliEnB q llp.ltqEr i5U$nhhw)r otolpldbn,llEO*G &ills * Lw llE h,&rof Foli,E rh. lE q iE d! r.r l ld or inlFlr! lh. F$qq tu rrE FrFEof I. aos6of r& trp6r), m.!.1u.*.1). cod'&rna uirh l,c.E d $dracroh lo codrucr rl! Fr.t (S< 7(lll,IlciK 6d fiotsi.n Cod. fi. Cont..l.i! l.ic6!. l-N rlrB nor .'lplr ro M o$ 6 ol roFn) " h. buil.,. or inpor 6 rh(on. rnd sh.6iteBior!u.htrojc.li*nhaCo.r[cn,(s)li(.*dpuEsntr!]rh.(.nrmr6arl-ic@l..rv) I a .rnF ofrlc. Sdb. }ltatrE&xouff;$iar!]!DlllAldllgr! I hd.by rmrm unds lEnahyolFJury...ofrhc foll$rinS ddlaralioB I h.v. rn *ill mn rh. (.rifr.l. of (nlen ro S.lf-l6uE rG *Mt6 onFsdirn. 6 Foril<d lu qq s<irn 1700 ottt lib.r Codc fc lh. Flolrll*. of llE wort a *hid lh. Fnn i! isu.d. I h!r. !d trill minl.in *o,ld co Fudi,. 6uld.. d r.qu&d hL S<rb. 1700.f rh. lrbor (td.. lor rlE Ffollruc of rh. *! fd *'lth rhi! Fit n ir$.d My *!rid- omFla-n iBuft. @ii id Flt) nunbf .. l.ditrhd ii 'hc pGfo@a. of rh.\oE lor *hich rh'r Fmi n Bu.d. I !n!llmr dnph) !.! F$n in rnt mdB b abbd.mslqdb E $orld .omFdion L$. of (.lifomr . +r rh. ill Jrutl b.roru Jut.d 'orlEwrl6 ontEsllio. prcvirkrroofSdtion lr0Oollh. tlhr (bd., I !h!ll. lonh\rnh .omply snh tlFr pmvi!i..1 WARNINC: F.iluE ro re etk@' cohp.,slln'n m16!s. t uksful. dd lrull subirl o nrlot( io dniMl Fuhb &d .n,l 466 up to or nund.d rhoend {hllG (tllxr.uool. i. lddnnn ro '7F^"' **'d'r rrt\ir'rr tu rrt .lrh.li&rr Coi.. imdd .nd krrft\r.rrrri{ru(roxut( &!ra! I n@bysmrm und6 Fnahy of Fjury rhal I dn li.a*d und6 Fotieiotr ot( h!fl6 q lmnn.d(ins Nilt Sdhn 7Lm0) olDivi!6n l of rlE B6ilB rrd PmaBi)B co&. in my lkN 6 i. tull lora id.fid *I-4 - L6 ,""r..".\ calsrBul1lall.EtDltc-Acttcr I nn by lmm undd tinln, of Fj!r, rhd rh@ b . coiHtu.lirn LndinS .go.y irr rlE F, fomc. of rh. $ orl f.r \ hicfi lhi Fnn ir ilru.d (s<. 1097.Civ C ). AIILICANLDESISSIqN I lEdy .r'm und6 p.f,.hy of pdjury oE ot lhc lollnving d(lddl ion!: l).mlhio. P.mnt-Arb6ror Ndifkarhn l.d.r!l R.luldhns { I il. 10. Prd6) R.qun.{ tdrd of NolifEdhn ,l col it rha rh. t dal rquLlioB r.3rdinE atdos rmr d u. a! {plt.bL ro rhir l(!.< l.difyrhat I lBr. rod ihi! .fplic,rtun &d sr.r. 'hd rh. abv. infonndtun is.orRr I.srdkr.omFlr Nirh.ll( !!trd(ounty ordi md.nd S'r.1,$!Gld,gr. t{ildinB coNndhtr !n hd-r.| ru,rl'. r.F.g'1n6 of rhirCir lidCouni) lo o16 uFn Effi:ff,;;:..X'ryVf trmnF n.m. r prlnr l: tl-tl- t 6 Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Roof Sheathing Shear Wall Framing lnsulation/Energy 1.?--t1 ').56*14 ) Drywall Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req. Deputy Final Report Engineer Final Report Flood Zone Certif .t,l FINAL 7/t/zu A;k//z t uao6 Certificate of Occupancy Notes, Remarks, Etc k,+2 ,7 Z-<7v Subf loorA/enVlnsulation