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BUILDING- INSPECTOR RECORD
<br />I hcr.by rffrm und.r p4nrlry of FrlIry $n ! m .rcrg'l fEn rL C.tudc tirnE lj! for $. folbwinS lw)n (Sn 703,.5
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<br />lmvid.rl rht! sh uFDmtue d irdrHndE td fr -l l( hoM. dE bildDg a frdenElr !! Dld *rhh m Fr
<br />6fodrhli@ dE ol,E 6ui!s wil LE ti hrd.n.rt Fovi.8 rL lEorcE dn d b{ild or itrp.Dw dE FoFr, for tli F Po- ol
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<br />rnd t!trGsirn Codc: Thc Conkkttr'x l,E.nrc l rw J(f,\ iot {ttly k) o$ner oflrcP.ny*tu, build!.r inrln)E\ th.ionr.
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<br />DECIIEAIIQ!
<br />I lErcby rflirm un&r pc..rry of tEtry .E of rtE tdk,*in3 {k{Lnl i,nr:
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<br />h.E ad will flintri. r Cdlifrd. of Con-il lo S.!r'ln!c f( ffit6 onFB.lioc $ Fovilcd aor by Serbn l?m ofllE
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<br />rtE wt tq anth rht Fmn ir i.!.d. My qxld .!dF rao. in$lrc (ait rn Polty nur$d e:-D
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<br />*od6 .onlEnetion pmvibns olScctn'tr :l'7(I)olrlE htrr
<br />WARNIN(;: Fnilurc r, s(urc $orl(dr\ ronllx$ i,tr,.ov.rr!c
<br />rivrL fitrcs u! ro otrc hunlr.d lhouurt dolla^ Itlrxr,(XX)), r
<br />s..rtun :1076 o1 rhc trhr (ixlc. inr.(( d dktrr.y't Ic\
<br />l. and shnll sohj.cr s cmfby.r h .nninrl flcNlri.! and
<br />b rh. co{ ol $nI{ \nrtr11. (l, Utc1 r\ t,,'vklrl 1,tr r,r
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<br />I cnify thar in th. rE,formm or rh. *ork ror whth rhN Fnir n nsE{t. I .h.ll mr .r{,loy rny Fmn in .ny mnfr
<br />s a! ro tr<,rc subj(t to ttE eork6' d'rqEnslion lrwr of Cllafom( and .8R lhal if I olld bccoc rubFl lollr
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<br />I hmby lffm undcr Folr, oI Frru., tlu I 4 liat d udcr FDvtbn oI Ch.pio 9 (offiin8 rirt Sdbn 7@) ot Davni,. I
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<br />IIIBEIIT(:IT}N!EEOIIG.AGEICT
<br />I rrEt)y .ffirm uni.r rEulrr ot p.Dory rhd rlEr. ir r crNMb. Lnlhs rs.r, rot E Frfornure or lh wt ltx $fi.h rh$ i.d t
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<br />APILIISNLIIECI.ABAIIQN
<br />I )mh, nflinn utrdcr p.nrlly!lpcrJury oN ol ihc li,ll,rwi'rg.tc.llrarrn\:
<br />ILnDhionPcrmirsAstE{ro\Nrifi.!ri,'il.c,l.r!lRcBul!ri,nx(lirlc40.P3n6)
<br />-Rcquircd
<br />krrs ot Nottturi,'n
<br />Egrdina rsh.ioi rcm,vrl c mr lprltd,k ro rhn poFr.
<br />rhi dr rh'w ,nrotubn ir cord I r8r ro onply snh .I Cn y ud (tunry
<br />ol rhir Cny .,n Co6ty ro .trrs r{E. tlE
<br />Applic&l or,\Edl Sieml
<br />SITE-WORK DATE tD/stG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsulation
<br />Floof Sheathinq
<br />Shear Wall
<br />Framino
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Beq
<br />Deputy Final Report
<br />Enoineer Final Report
<br />Flood Zone Certif .
<br />I l
<br />e7FINAL1?A A vA/q-
<br />Certiticate o, Occupancy I
<br />Notes, Remarks, Etc.
<br />o 6aq-(t.*
<br />,t I
<br />Ja; '<'" LIT 11 't\
<br />(E (c.. s ?-
<br />fonnwirhon l, *ath rh.$ pmvthnr.
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