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BUILDING- INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS OWNER B!ILDER DI'LCARATION I h6cty lrun uds Fuxy of Fjury rhi I m .ratrF fiDm rlE ( od...rd' Li.dr lr* fo, llE folowq r.en lli6 r0ll.5 &!ins dd frolBb. Cod.): Any Cny or Couny shrh cquic r Fmr ro mdN, .Ia, mForq &hlah or trt t ny siruduc. Fbr ro it! i:tuffi.. ito EqunB rhc lpplior for .Gh FDn !o frL i li8f,.d ]ldmdl lhll h. or *E i lka!.d Fel,r to rlE FosioN of dE Co.u.dn't l,i@nxn Uw (ClEd6 9, Commftios *ilh Stlion 7000 of Divi,bn I oflhc Buin4 ed Pr.f6iiB Co&) or rnn lE d.lE 6 d6Er th6.6on d rh. b6ii for 0!. .l4cn aar!.hn tutvhLrbnols.(bn70ll5byDy ap?li.ul for r FEn subiaB th. rpplicor ro . .i{il p.ulry of @r ffiE the fiv. huidlrd {hlls! (!5&l _1.s o* orrh.FFry. d my6rplo)6 *irh*!a6 a ttEir $h onFsriotr $illinsrLd oroFs.d fs nL (S! 70fi. Bdi6 od Pill<bB cod. TIE CodGrd'r LtoE bs <rE id +plt to a orE oa rfi. pri,Fry wh' hi!& or !p.!v6 rrEs( d who d.â‚¬ Mh sit him$lf or h.*lf or l,mlsfi hir or hn om mdotlq psvid.<l rhn luch imFiroE iemr i,'roi.d$otrord forsl.lL ho*6q, rlE tlildirB or imFoEE L!sld*in4oE'd oforpLr4 rh. O*E tlu'Bn rill 16! $. hr&i ofFuiig dr lE or nE dn d hild tr itFlE ln. FIFD br dE F,pd oa -1, s osE of rh. Fot'6ry, @. l6iv.l, conlrdi.S snh li(.B.d corrdoclo @I,ruci rlE FoF<r isd 7041, BGiIB ad PtDkno Cd& TIE ( otu cror't Li..u L.* &s Nl .pply lo d o$na orFoF!! s h. boild! o. ihprcvd lhdon. ud sh. o'I,r$ tor !u.h Foir! *nh . Codtuo(3) lE.rE d pnM lo lhc codrrdd'3 Lic@ k*) -l m .rfri un&r 5{l /e 1,2:S-Q! u!.1.!.!B.lr.lu: I hqar! .md un&r pdnhr olFJuD.I oE oailr lolloq iqr rk l&.rF6 -l h!v. -d will @inl'in . Csrific.r. ot CoMl to Sdl-l6ur. fn mlda onlFMlion, 6 Forid6l for hr S.niot l7O0 ol th. LtEr cod.. i rh.FIo'lie. of rlr sat for stth llE Fni i is<d I hdrc and will maiouin woi(ri cotrrp.N.rion isu!n.c, s ..rlun.d by S<t hn 3700 orlh. lru Gd.. lot rh. Ffomucc ol th. norl tor which rhis Fni i (aal Myrdl6! comFuion inuffi.ceis d E,hcy nunbd e! -l.diryrhd in rlE Ffolrrlft.oalfic worl f( shah lhtr pqD'l 'tr 4u.( I nullnor mplo) &, F{n itdy nmod s u !o tqom rubel lo lh. srl6 omptun'n bs nf ( .lifomL ud !â‚¬r thtt n Lru[l b<om. tubicio rtE solla emFE rior F!vai,6 of sdio.l7mof E hnr Codc I 3lEll. forlh* nh @ody *hh rlbr ForirhB WARI\ING: l-.ilur. io sw *uld oBFurion ormsc i! uL*tuL ad tull stF 4 dph)r lo frni..l Frhit !d civil nn6 up r(' on. hurLtr.n lhousnd do Sdn n rc76 of rhc tlh, ( o{c inrsd !d 'l i. odd ion ro rhc.or oa comFsrriof,. d846 a Fv'!.d for th. I tFctr lrm und6 FDlrr.f FJu-_ rh, I m lk6a.d Fldrbn of Ch.{,rs I (onnE6g trnh Sdbn dJo) ot DillDn l of !h. Bui.d &d Pmf6io6 Codc. dd my lic.N n D tull hrc. ri.ifdr c!)llIalCllllIuEUllxG.AGEA(} I hq.!r llfm undd p.n rof Fjury thd th6.ir.otrdrudion Ldins ostr] turh.Ffolli1tr.of th.w{k for*tihrhnFnn i! is.d (sd 1097, civ c., Lindd'r Nmc - APPI I('ANTNF('I ANAT(IN I hoiry !6im uid6 Fn.hy o f Fjury orc of $. aollo$ in8 d..hmt ioc Dcml'tF, PonnAet'd6r Ndin.dio. F.d.r.l R.*!hbni (Tnt &, Ptn6) Rcquir.d L!rd oaNolifi carion -l cdiry rhr rlt ftdarl .cguhrioN Egrdj,C dtd.s lgft\d n nol 49liobl lo rh! FF -l cdi0 thd I h6. @d th! rrdk.li,n -d r1. thd tlt .bov. irfodrtio. i! cotr.<r I lgrc lo omPly wnh .! Cil, &d Co6ly odi..sg xd $a. L,E Bliir io buildila cotudior .n hdtby irhoria eFErnns of lhL Cil! -d Cou,n, lo cnc 4on dE atnv. mnloncn propdy tor /\ppli(rnr or.\.nrs13nrru n /e - 22 -2o17 Alhr'4 /luyat4 Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Subf loor/VenUlnsulation Roof Sheathing Shear Wall Framing lns u lation/Enerq y Drywall Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req. Deputy Final Report Engineer Final Report Flood Zone Certif. FINAL 0Dr1ltl.1 fuai.rsx '?)) Certificate of Occupancy I U\ Notes, Remarks, Etc o.,.. /- - 22 -