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SITE-WORK DATE ID/SIG.COMMENTS OWNER BUII,DER DEI,CARATION
<br />I h..eby rfim urLr FEly nl Frury lhn I d cr.nfl rmn tlE ConiBlo^ L.!ns lr* ntr rh. roll'win8 E!'n lStr 70.i1 5
<br />Bulitu3i d Prof.sbr Cd.) Any Ciry or C(rdy rhlh r.quirr r-qmi ro .Tn{Mi' .Xd irr{'mw. &frrlEh or r.Ft v
<br />dtulm. Irir n' irr tslsc. d$ ruquirct rlE rpl,lioi fd rkh lErmi lo liL r riSrn {r.md rhd lt or ilE ir lia.si Intud
<br />lo lh. ruvnionr or ltI conrrrroir Lic.nsd Lu* {cluplcr 9. con nEir3 wirh se'riln 7oo ol Divisi'n 'l ol lh. autift( 'id
<br />PmLssx,nr Codc) or rhi lE or rh. is crcnlFl rh.rcfnrm dd rh. hdsir ror lhc sllc3cd.rcr{,tion An, vi6brionofSclli'n 70.1I 5 bye'y
<br />aFrlclnrforuFmiriobFulhc.,:plicorlor.,ril,'.n!ltt.fmtnrErhtufiv.hundrcddolleilsv ).
<br />-1.
<br />.s ownr of rlE F.Fny. r hy ctpktF( *nh u8.r.r rlEn :rh 6iIEns.lion. *ill.l' tlE H* rn llr {tdc ii n'
<br />idcnLl, or o6.Ed lm sL ( Se.?044. Buiiftsr Fd Prof. i.nr Cd. 'nE C.nrsrol s l-iu- tle d.rr ml !rpl, ro u olEr of
<br />rlEF,pdry wt t! & o, inptuB rh.En. tld *lI) d(* *h M'rt himr.lf ot h.rcll or llFo8h hit or hs o*tr cnl, li',tts.
<br />p.""rta rU *t !t+(,wtr3 ft d -r.d.d n olH fr 6k lr, bw- llt hu'XiiB ,i iqmErtr n $U *ilhn oE ).d
<br />ofrcq,Lri* rL OqEr BuitLr *ill lIE rlt htd.n of Fdi.8 tltr lI .n sL dit B, toild m iqmE r,E FbFnv fn llE FllFfr ot
<br />l, rr o*F of rtr F{6r. m crclulit.l, codMin! urh lrcn{n .onn&iou to mnnru.r rrE ln'Jcd lS( 7lxt. BunrcK
<br />l\oiaii. Grd.r Thc Conk*ttr ( l-i..n( Lrs &xi rn aml, ro mo$K orFoFay $ho nuiit!or impnns 'lENn.*ho conrhr6 rrtr $urh rxDick snh s ConrMbnr ltcnrd puBd i rh. CiinrBroi! l-k.nc lj*r
<br />_l m cxcn{i uni.r Sdi,n-
<br />.lt!8f,L&LCAnrE$ArIIl!
<br />DECLrrEAfllr
<br />I hrrct'r llllr D undci pe'uhy of Fiiur!_ !E .a l lE li,lhr r! d..l,r{r irnr
<br />-l
<br />h . an *,ll minl.in s Cdia*d. ot o,r€nr r{, sclt In\!E n, Portsi $nl].nsou n. ur nEldd ro, hv S(riri l70o ol
<br />'hcL3tu Cnt . fd rrE Ftf.xlllG otllE wI fd ltth tlE lErnil i! srEd
<br />I hlvc rnd will fluintiii *ork.rs .ofl{En\stiir i'xtru*-'d. rr qun d 6y se-r {)n lru) oI rtE l,hn (iiL. lM llI l*nolfun ' 'rrlr snrl trtr $hrhlhN ncmrr ir isslrd. M y *trtcr' conqxn\d ion rtr\uruncl]micrMl F'licvnu,nhcr d!'
<br />l.aniry rh.l in itI Fro,mtur otrlE *orl ru rh.h rhi. Frnlil ir a.!td. I dulltrn.n9lo, rnl p.t$o i' rn, mnmi
<br />v, K r, lrom subj.cr lo lh. krtl.B'.l,qEnulhn la,\ oacrlirDmi!. i.d !3E rh,i ill ilnull tcoft rlbFl hr,r
<br />*o .B.ompcnetionp vishnr ofs(xon:l?l .frh. Lrh, Cdlc.IdBll- tunhwirh donlolv *irh rhr* Imvnion\
<br />W RNING arillE ro sm *$rt6 n'dFn!d('. o\.Erc t utrllurul. lnd \h!ll \{hj.rr !n.fr,lo}tr t' ffrn'l |rml's lnd
<br />c,vil rirr ur b tr hudEd lt,u{nd ddl'^ lS lu},(rf,)). i,r .dd i,n t, !,E con ot .oq.nsrion- d.E8'i rs l"vxhd nn rll
<br />SNri,n ll176 ofrh. ljhr CqL- hrcEd..d otEy'sfe\
<br />o.n, !p:1:!i ^o^^,, ,l .{2.4 4L*4
<br />LrCFiSm COMrI|rL-ntI
<br />I'}:IIIAAIIAB
<br />IhcNhyoritrund.rnnrlryofFiurylhalIr li(nsJ unld lmrnhi ol chr/d 9 ((onrr i.8 *irh Scdi'n 7tm)olDnki'rn 1
<br />ol th. Bus,mss md Fmf€rlons Cod...,n nly li.cn$ n in rxll toat ! .rratr
<br />.-19
<br />I r(ne Nun {r
<br />,""*",d -x-d 44-7/t4
<br />CON\TII|('(TN LT\DINC {:Ti{('Y
<br />I rrFhy .ffrn undcr Fu!, ot Fjory rh.i llEr is . onqdi,. !dh! ryd, to. tlr Frfi'1lsc or OE rarl for ini'h rhn Fm' i{
<br />trlcdrsf.ltn7, civ a )
<br />t ndo r Nle
<br />ATTUI;AILI}IIIAIA:IIO!
<br />I hr.by .fm undcr Fnalry ol ,E.iury oF oI rhc lolk *inB &{Lrtl i'nr
<br />o.nrniotr P.rmih Altxrlor Norifr.lhn Fcd.'.| R.SuLrbr\ fl ill. 4{r. Pd6,
<br />R.quiEl Ldld oI tldif.rih
<br />-l
<br />calify lhd rtt f.rbtrl E8lhthN Errda.8 .!rr{.i Emvd {. r, {'trli..bb lo lhn ,n Fr
<br />-l
<br />cnif, rhar I lrE Bd lhit q,plirtion an.ur. rhrt rh. rtnw innrtn tion acorcl. Iusr roomrlv wirhrll Cirvrnd Counlv
<br />ddiulE6 .!'d Sl.rc Lrs Gtint io hiSins c(,fub.. .,n Er.l,y tullbtir EFlerrdiB ot rhi! Cnv !n C.unr, ro .nls uFn dE
<br />Iz- r- \8
<br />rh . 'h'nrrnrll n'ut{nv htr,n\It!rhu rurF'a
<br />{pprkln,orr,.n,si*M,uR \ -n X4l/4
<br />Set BaCKS
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framinq /o-3 - r9 JJ.l*olfr
<br />lnsulationi Enerqy
<br />Drywall 'o-? -lB 6@
<br />Ext./lnt. Lath
<br />Brown Coat
<br />I/ aso n ry
<br />Pool Fence
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif .
<br />FINAL /o-y-/8,l*ddz ,FD
<br />Certif icate ol Occupancy
<br />Notes, Remarks, Etc
<br />BUILDING. INSPECTOR HECORD
<br />T-Bar
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