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SITE-WOHK DATE ID/SIG.COMMENTS OWNFI' EUILDT.X DEI,CAIATIOIT
<br />I h.,chy .r,m u cr p.nalry ( FrJUry rh.r I m .r.n rom rh. Gnt(tuR Lirns hq io lh. t()llow6! rdsr (Sc 70Jl.J
<br />Br.irri Dl PrultsD. C.J.): An, Cny or C.u, , ,hrh Gqu@* . Fmn b (,niocr. rxd, rqirck, &@lirh nr EF! uy
<br />.r&rw.. rntr nr 3 sruxr. js EtluEr rrE .rrlrel for rBh rtmr nr nl . ll3Erl dr.nEl rh.r lr u tu it lEt*1l I'{e.d
<br />t' rtE Fv6Mr.l E Conht 'r l-r.Gt Lw (C-1IF., 9. ColiWLmS wnh Sdis 7qD ol Orvlitn I .f rlr Bu,mss ul
<br />Prn (n,ns Cqlc) q rh.r ll G rlt n c&n{'r rlEatu'h !n rlE b.i! nn rlr .lLsctl .r.r{ru Any vxllrr6of S<rrrtu]l5l,y.ny
<br />applunr t, . Il.m hj.rls lh. lFtlk.nt lo a .ivrl I'.Dhy of nor fr'E ttun fiv. hunL[cd doues (tlfiI)
<br />L $ ovB or rh. F)Fnx or Dy .mplotc. wnh wr86 a Er ik on{ENrsn, v (r) tlE wi In llt tlBlG 6 mI
<br />darj.J r ofial n, rl. (Sa ?o44, BBffi.,l PridrE CoL: TIE Conlr-lri LrtE b* d-
<br />'El
<br />.I?lr ro x oyc of
<br />ill F,tEr, *tn hrlllk d !r+.oB oEE& B! *,rl LtB rt *,t hrlNlr or lrll or rhNllh hit d ta lM.q1rot6,
<br />n ovrL{ rh.l suh !4ownt E ni nl€rlol r olftrql lir s}. ll lDytc, lh. tllllua r irtnrcrlr B p! e ho ,E F
<br />oi conuLlbl\ rtE OwBr Bui!6 riu hlE tlE trtr&. ot ln)vlB $.r lE or rlE di mt bollr dr aqmE th. IntFl, lor UE ,{rp.* ot
<br />qLl
<br />_1, ...rE olrlE F,rEiy, rn.r(hnElr 6tur16l Mh lNrEJ..turr6 b ri,riBl rlE FrFl (Se. 7044. aEffi
<br />Irl ttr)tsm CuL: Th. Conirntr r l-t.rE &r ltEr Nr .rrlt ro u osmr ol FqEny eho nu!!t n h9rer! rlmon.
<br />.nd sho s nck rrtr ru.h FoJ.(1, wdh i Co frtu(,IE..$J puBuur ro
<br />'h.
<br />O'drdoir L.tnr tap).
<br />7t
<br />DECL IATION
<br />l,rrchy !llnmun.lu pcndlryoirEriury.kolrlrn)ll,|wm8 deldrl!'"s
<br />_l t r.d wlll mor.x r Csrifr.r. ol CollsI ro S.rJn@ f( Yxt6 otqErn lnr a FoviLl fu tysd6lm of dr
<br />Lrh* Cdl.. rd Or F orllui of tL urt lv *nd rll Frur ! ErErl.
<br />I hiv. rhl will mlnru,n worlcrJ rnmFnsrtNn rnstrrn(c, * r.quft.l hy Sel t'n lzx) dl lhc tf,hor C:,Nlc, n lh. Jrrturms( ol
<br />th. utrk l'trph.hrln! FrDt ir r$aj Myworksi ('mJEnst[n ,nrur.tu. ffrr n] Fnry numtEr e:
<br />IaI C\
<br />-!
<br />r.nrlyrhar in rh. DolomN. ol ',r worl 16r *hrhlhispsmr n nxk'l.l dullfrn.nthyoy t Eon i!.o, tunrr
<br />q, I () l[{m ruhFr ro rlE ux}6 ur{ryrx,. Lv. of C.liromL ri '3e rhd d I dDull bc{om obFr ro rlE
<br />sfi.$ rlrr{Enrrr'. F)ys6nr ol Sdr k lruOotrlE trhr CGL,I aElL nnhrnh (.iFly pnh ttt)r FrvEaB.
<br />WARNING: 1. u.. t) cw yrL6' co.{Ehr.rr'n evcdg. ir unlNrul. dd rhrll hFr .n .fl{ .'F b ffil Fnxs &l
<br />rivil lind up b or hun!rc! rhour.nl doll0s ($lUl,mo), rtr !d'l nr n, thc.1lrl ol comr.ns!ri,'n, Jrm8.s rs provllcd nr lh.
<br />S..run U76 o, rh.lrlrtrcl c inr.r.{ rnJ t4o/r,
<br />lECItSArlod
<br />I hcrhyrrrnunlcr p.mlry.l !.rjury lh.t I m llccNn uft].r nn^ni'n I Chlnrd { iommn! in8 * h S.dion txjirrorDri.i.n I
<br />ol rtF Bu\Esr d ltt,rcsotr\ C,xL. rd Dy li..n{ tr m lull ,nm ml .fin r I
<br />co$9f,!8:Ea!IE!!aclgI!!f,
<br />I h.Elry llfrn unJ.r Fuhy of FrIJr, th.t rhm E r otrne.rbn hnlrni .8.my f tu Fft)l118. ot rh. wdt lor wh.h rhn tEtu !
<br />rrucd (Se 1097, Crv C.)
<br />AIELICANLDECIJBAIIOB
<br />I liod', dim un j.r Ftr.lry of Frury .rc ol llE folb*in8 JeLr.lnw:
<br />D.B,lxrn P.oireAlh.no. Ndff,I&n Fcj.r.l R.SrLti)B fink llr). Prn6)
<br />-R.gukn
<br />k(.r ol t{{frrun
<br />_l edily rhd lhr lahrn rcplli)B Er.{in8 rh.no! ,.tuvrl a nor rmli.'bk h rhn fioirr
<br />tll (dr, thn I llr Erl rh! rprrx.rnn rn uxc rt r r,E .h,k oi,mrbn i! .rI,B-r I .ga ro d{d, rlh dl C!, .d Counr,
<br />orhaR_.! rn! Srar.lr*{ NLtu3 n, hu l .oldtuiDr .!n hd.t t llnl|ra r.t'..rll'!6 of rlu CI y Jrr Cou"ry rr, .ntq uFin rlr
<br />rh,!. trrtrrk,f,Jl)lrn ny rrtr
<br />Appli.,nl.r,\!.tr1 si!troitr
<br />?e,4 ez-e
<br />B 4/3/2/
<br />Set Backs
<br />Forms/Steeli Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf looriVenVl nsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framinq
<br />lns u latio n/E nerg y
<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 />FINAL 1-2-cI-2t *d $z--
<br />Certif icate ol Occupancy
<br />Notes Remarks, Etc
<br />BUILDING. INSPECTOR RECORD
<br />L&(c CL$:_Li*M N!6ltr:
<br />D.l.: Cant L.
<br />- ---r------
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