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SITE-WORK DATE ID/SIG.COMMENTS OWNEI AUTLDEN DELCARATION
<br />I lrrchy.lfirm uold |EMlry ol Frlury rfi l m.tctr{,r fn,fr rrr (hln .ttr. l-t.nr l^ lnrl& foll'*nis Er$n (S.LlOll3
<br />Bu\iBud hrrdrion Cod.,: Arr Ciry or Couhry Bhi.h r.{tun.( a F.mir ro $nrM. rlid. irytort- {hmhrh or EFn My
<br />{ruduE. fi, h irr $umc. !k, equnci rh. +tlaM! fo. rst Froir tu lik r .i8ncd ndclmr rhrr h. or sh. 6 lifttrsd pumrnr
<br />b ihc F)vhi,ni of rtE Conlrulq\ l.itnan Ur (ChrFd 9. ConrNnls $irh sdrnn ?uX) of Diliri{'n.l ofrh. Burin.s md
<br />Pmtusrn'nr Cd.) or rhd h. d.lE t.rcrfl llEr.fnm.nl rhc tEli\ rr rh. rllcS.d ctcmprion Any ln,hrionorS..tin70.ll5bvrn,
<br />urrlk.r fo..Fmit rulijek rhc .I'Fli.rnl to !rililFBhyornor mrcrhln liv. hlndr.d dollri ( 35drr
<br />L!ro$EorlncrrcFir.orfr,.nDloyerwilhwrsc\6rlti,$L..nIEndiod.f,illt,.irh.wk.dtlEd Min
<br />iNsrhl u olr.fti fm sk (SR.-,lB,l. Buiircs trl th'f.r{,n. (,i. I h Conrartr i l-ilnt bw dEr d qDlv io e oEmr ol
<br />rhc FoFny *hn friHi or iqnEr rhco{ {rl wh,lll.truhH',1hini.ltnr lErtlfor rhmuah his o. ts oqn.rylo}s
<br />rrolid.d rh.r such mpFftrnr. h n i c,i.d oro,Icrn tu sk lt b*w. llr hiuins or inFkEd k old sirhin nm Fr
<br />ol $r,tilcti,n, rhc o*8. Build.r wil &t rlt h!d.n ol |n vL* fir h. d irr dil d taitl n int,.E ilt FoIEl, rm dx ,rqhc of
<br />I.r\.wrr.flhcnoFnI rn.r(lunrcly.onr6ri.S*irhl'..fl{dcontero^n'(r,n{tu.rrrh|)l.,.d(S..7lll.l B!{k*
<br />ad t\onl\i{ (ixL Th. (ontrttr \ I -kcnr ll* &tr mr .,}Pl, (, !i o$n.r ur ,ropcn y *ho huildr or im0r,vc{ lhcr.on-
<br />and slr, c.nrmk l',, rNh rn)j(k f, h.(i' r.donr) lic.nf,d por srr k'lhcO)nh r'\l-k.n{Irs'l
<br />_I m .k6I, uidd Sdirn-
<br />Irrr. o{E
<br />I!1)B&'EL(aTIIINIAIIONlrisl,l&lnoN
<br />I lrr.h) ilhr trn(lct pcnrlr) or rritr, Dic"lrlr tI'll,i*trrg f.lJrrr(m\
<br />t hlvc.rnwill mior,in r Ccnrr.src of Co.c.r tr S.lalnruE f(, r. sa dn{xnok,n. r( Ir$ilcd t hy Sdhn ITIX) ol rhc
<br />llh, C.d., n, rh. pcrfo.nlm of rh. *o.k tu whth llr ncrmn C ilrun
<br />-l hurcud*ill rimcin so,r.( coqrnet ir in\urat.. I r.qurc1l ht SNr nn l7u) or thc I ih, Codc r.r rh. p..i'rnurc ot
<br />rlE 'o lnrrhih rhn F.miri irul My rotdi cD {f,6d'on rnrur.ft'. c,rs lil lblf,y numbcr ec:C'
<br />io-t8-\4.
<br />I r.nrlylh!r rn rh.Frnnn!'rtol rhc * lI I', uh'.hrh's trnnr r\ ^\krl.l \hrlL'ri cn\'!)vitrII!.rvrtr
<br />'n
<br />nn) ran*,
<br />v, .,\ t' tR1'nr \rhFr r' rhc *ort.r\ .rnnF qnDi
<br />uo,k(\ dmFnsari(nr fro\Fi'it nr S..ron l7(l)ol
<br />\4ARNIN(; I'orlurc tr' s.u. *, r\ N q{Hlk
<br />.r'l linr\ ut' k) om hu r.d rh,o\rid dolhh (!l(
<br />S..r(nr 1016.Irhe lilrtrclr]t, r crr{ lktdrorr\
<br />ir I lh'u|l lE<,m \ubFl tu rlE
<br />r M .,p*,Fr r. dmi.,l Fmtar .nd
<br />orion. d.roIc\ a foYidcd fttr rh.
<br />\O 2-tb
<br />I trEb, rffun unhr FMh, oa rErrury rh.r I d lRscrt und.r F'vi\io. or (]',fl.. s rnh sern. ?(xtr) ofl)itNxrn t
<br />nl rh.llunm\ rn,l l\olc$tr,ns (irl.. f il tr,y li.cn{ ^ lull ntrcr Jtl?lltcr
<br />L ,/cqv \0(891bF{effiLlQrZ \
<br />cl,lN,t[8JJ!]IraNrurac-{tiENlr
<br />,lENb' atir undcr Enrhy or n lliry rhlr th.rc ir r .onrurir LilinS .ScE..! fq rlr FaiormNc f rh. qort ln f,hf,h thr IEmn i\
<br />rsu.JrSR :l(/r7, Crv. ( )
<br />l.trtl.. \ Nrnk
<br />-
<br />APPLICAN DE('I \R{'II(I\
<br />I [a$y rnim' u.rl.r Fnrlry ol Il(rjury ud ofrlx folhsin3 lm!hrdrr\.
<br />l)(nrtliri,n P.rniN \hcit)s lliii'.rrir I'cd.hl Rctuldir)nr llnl. to.l'r 6)
<br />RcqutrcLl Idrerrl n(i'rirri)n
<br />_ l .cnn y rha hc LJ.hl rcSulalD { rmlkrhk t'rhNlrrr(r
<br />1.. 'rvrhrr I lNr runi rh'\ r|)|)l
<br />,trJtr frc\r n Srrrc lis\ r.l i"gr,
<br />I rsrc tu $'r!ily rnn lll ( iry,trd Counry
<br />trrhtrn.rcticcnrrt^c\olrhRCnyn CotrnryroctrrLrnlr'nrn(
<br />uttr. NnritrEd pn,rny ftY inrF
<br />:\pplirbtrl Dr,l$nl Sipulurt
<br />M
<br />[r:Z:tb
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />Subf loor/VenVlnsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framinq
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coal
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />FINAL /a/z ?//7 --&(//)7Certilicate of Occupancy
<br />Notes, Remarks, Etc.
<br />BUILDING. INSPECTOB HECORD
<br />l()3\
<br />UFER Ground
<br />SLAB Floor
<br />Flood Zone Certif .
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