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SITE.WORK ID/SIG.COMMENTS oWNER BtIII,DER DI]I,('ATATft }N
<br />I h.rc$y ultum utuc! ncnally ()l nerjury rhtrr I m .rcnrd rr,'n rh. Crnk!.rtr( Li_ctrr liw fot rhc n,lh*inB Ersr ISN 7lr.1l 5
<br />trusin.( !fl1 Prcfcst,. Cdcr: Any Ciry or Counry rhi.h rcquir.( r Fnnil ln consrtucl. !116, nnPhv.. dcmlnh or rcnnt lny
<br />ntu1uc, Firr, ir. tsufr...1$ ft1utr.1th..nr t.d lG srch IErnir h fikr riSrrl ndcmd rh.r h.o, dr i! liftn\.rl Pudrhr
<br />ro rh. F)i*,N ot rhr Cinrarn'i Li..ncd bw lclulll$ L ConrmN'n3 r'irh Srrri)n TllX) ol Dirnirn :\ ol rh Butircsi .nn
<br />Pmt \(k,nr (-,xlc, or rhat lE d !E h.xcn{'l rlErciion lnd llE trsis fd rh. llk8.d cr.rgri'n Any \i'l,ri(,nofSda.rrrlI5 h! inr_
<br />opflica ntr u Fnnil s!hr.c[ rh. rptli.ud r' dcivilp.ntrlryorfr,l ntr.rho fivc hundrcd d.lla^(t5OD
<br />-1.
<br />!\ owrr of rtE rr,ltny, m nt .rnhF( wnh r.!.r ir rrFir s'b .arr{Etrdi,n, hll iio rh. r'dt rn llt (nrr@ n ni
<br />dor&rt d ofid.d for {k lsa.7oat. Bu.iF(.nd Pr.f(6nr C L: Ttr (bdtdft r Lr.N t s dB r'l .I4it t, r. or m of
<br />rh. I'qEn, rhr hil{r oi iqmrB thdam, !n sb.Ia uh wrk hilEllor hr{lr.r rhn,!!h hn tr lE. o*n.rFbK1
<br />tmvid.d rhur ru.h impmmnlr N mr idodcl or ofir.d ftn $k li h,w.6. rh. toildin3 or ir{mErd n $B *irhin oft ,t
<br />, - l Lonphrr,n. r lr O*mr tlu d.r wru hlw ttr tudcn nl F*in! rrul h. or \h. dit (n toill or intmlc rhc Ptr'IEry fn rlt PxlJrr< of
<br />vrff,
<br />/-t. -.*,*, "r rt n-noy. !m.r.lun\.ly c ddhs *irh lirtn*d.odr&iou ro on{Ml rlE rrj.{ (sr rEr. BurE(
<br />rl PblisiflCod.r Th.Contrdolr l-rcnt. L.s dci fr, inplyt, rnormr ofrmp. ytt buildr or rmrovct rh.rco..
<br />lnd sho onrEls fo uch Fftrj.EB wirh , a)nh.n( n lkcncd nu uMl k' lh. Co.rudoi\ Lic.m.llw).
<br />h/t3 Zi:rl/"
<br />u!u Ia\
<br />I hcrby rili,h undcr FrhrnrFjuryoE.f t,E rolhsihC &(L,.rbn{
<br />-l
<br />h,!. !d rill roinru tr C.nifrrr. of(i{{nr tr Sclf lnrurc ltr *,rtdr oqrnsrhn. !r Forili, fr, by S6rir l7{I olrlr
<br />ljtor On.. lor lhc p.rfornDrc of rlE *brl fttr whhh rlt lt mir is n<!cd
<br />-l
<br />hsv. !fft will mrinhrn w.rk.E comFnslirn iniur.Bc..r rcquiLal hy SNr bn .lTlI) or rh. tjhor (i c.aorrh.F ontuk of
<br />rh. f,rrl lfi f,hi.h rht JErn{ rr rqEd My }.rts d'rqq\.lx,n indrrrr.uid.d Fn*y nurlq u.
<br />-l
<br />c.f,tly lh.t in rh Fnrrrr.f rh. sork ri, *h{h rhtr Frnri! r rlhl. I shlll ttl .q,bt a.! Jxr!{ in.ny mnF
<br />s, ,1h tr$ft {hj.rt ti ttr wu.tcF'or{Efld hn bs\ of(.lit ni{ rhtl 53d rh.r il I rlhutl tE oE \ul,Fr ro th.
<br />wolrd{.oflFn{.onpn'vsi('.solSdi'nl7(x)ollh.l,hnC'de.lshdll.i(dhwilh.omdywirhlhrcln'liri,is
<br />$ARNIN{; I.r lLn. r, \\r'. \frLr'\ LLtr,'t).tr\xr ,trr \,1 xr. ,\ tr |.'trhrl. rtr(l \hrll {rhf.r rf cn,tn!'!r, h.nnrinrl Fl'rlif,. r
<br />(i\il lircr up lo orc hudicd rlx D, in .dd hn k) rhc .on ol coqEasrion 'ffi'""'"*^""
<br />614faut7
<br />l!t!Itul!r]
<br />I lrrhy.ftun uirLr Fuh, ol Frrury lh.r I rm lGnkn unr.r F,!kb. nf(lEPrd 9 (drnEr-iru *irh Sdi,n rUD, ol l)ttion
<br />or rh BuliBr.d Pmf.shN Cod.. ud my lt.nr n in full lorc ad.tTdft.
<br />1;llli!:[BlJsn,NL[NDrx!-acENl;r
<br />I h.fthy 'ltum undd FMlryoIFrFr,ltut lhd. is i d,n\rtoclin Lidiha !8cmy ror rrE IE n{roN. olrh. *orl ror rhah rhii Fnrir t
<br />tsEd rsr- $97 ci! c r
<br />knd.r i N.m
<br />-
<br />aPPLICINT nFcl An{rllN
<br />I rErt, l,Im ! nd.r l[nrl' y or Frrry oE or rlr follo*ini &.bnr i,nr
<br />D.Bniior P.rnik ArrEk( Nl iri..rn)n ltlcr.l R.8ullri.nr lTi'le{). P!n6)
<br />-R.rluird
<br />l.tlernf tlr ifrcarnn
<br />I Nn rry rhd fi. f.icrrl rcaularioN Elrnliry ditf,{(x rcmrlll ft D a {t l.abh t, rh'. ImF
<br />lrrn'lyrhrr llHr r.rl rh^ rtrli lnrrn trl nnrc rlurrrtr !lrr. ' , r[re.ticotr,f Y
<br />,,dinrmc\a l srtrrr tisi
<br />ltrnc.rDlnral tmpcnv
<br />Applic..l .r &.nl Slad
<br />iklir'll (.tr{n'cti,tr,. kl hcR$j_ trrlrtr'
<br />W 4^rnu,/;(
<br />Ll
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Roof Sheathinq lo LL tR ..<-(44[t:) zttt ,v"t s[a+b"-l/.-
<br />Shear Wall
<br />Framinq
<br />lnsulationi Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />l I
<br />FINAL + t".{-e- -tll *>,)
<br />Certiticate ot Occupancy I t u I \---.''
<br />Notps, Remarks, Etc.
<br />rtlI I
<br />BUILDING. INSPECTOR RECORD
<br />DATE
<br />Sublloor/Vent/lnsu lation
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