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DATE ID/SIG.COMMENTS OWNEf, BUILDER DELC R TION
<br />I h.Eby rtrtr u.&r p.MIy 6f Frp,, rh.t I d c&hor tum dr C. alon LtlE t * lor rh. follori.! rs. ts.r.ro.ll.,
<br />Ausim$ !d Pmr.shn C{n ,r Any Cny or CNdy whth EqriEs r Fnli' ro oMN. .n6, inlmE. d.mli.h or rF! uy
<br />rudm, piorto ft ks@.. .ls rcqut.r tlE +plt.fi for $ct ttmi lo ,ih . sigftn lce.t lhlrLor . n [..nsn tas.nr
<br />tu rlE Frvirir.. ot rh. conb.rd! Lt.lcd L.u (Cn 9td 9, Co.|ftxins rnh S.dbn 7m .t Divilitn I of rlE Buirs rid
<br />Pmlcsshn!Co&)dlhlllEnr|.6.r.iPl EE bn in tli b.rn ,q dE .llc8.d .r.qri,tr An, ti,lrli,n of Sdlbn 701t I by sy
<br />+nlio for r Fmir rubFcls thc rrrlictnl io !ciril!.niryofnol mEthr fiv. hundEd dolsr (S5@).
<br />-1,
<br />! o*8. of tlt F.rtny. Ey.np*,rr.! -nh q.!6 a llEr sL oqrnr.li,tr *ildo tlE scl !n dE rure k ni
<br />idci(h d ofr.Ed lor nl. lse.ro.tl. BuriB. ad Phlcsion Ccl.r TIE CodEldt LttN Lw dd. d +ply 16 m 0*6 ot
<br />rhc pn,Fny wk hrlt* or itr{r.B rtEbn, 8d wlb &B Mh h4 hituclf or h.mlf or tnhurh hn or ha osn cd}lo}rcr,
<br />thvitn rh.r tEh irprevEmils E ml inl.,'d.d dotr r.d fo. s! Il hoEE dE t iBits or irpr$rn L $U wihi! oE ,sr
<br />ot cd+hra rtt O*ffi Buildd *iI Lr th h!&r of ,mvi'! ,i li d tE dn d hi! d irp.oE 0E FDFry fd dE FIFE or
<br />_1, aowNr of tlE ForEny. rn.rclusiv.ly.onudina *ni fer€d.odekm ro otr{nd rtE Frc.r (Sr 7044, SBEr.
<br />.rn P!$6in cod.: Th. ConrEloar LiccnE L.s &xr ml .p?ly to u ovE of FoFn y qh bu'[r M in{,oEs th.fttr
<br />lnd *|r) onF.dr ro. rEh Fotrr! wirh r cD.b&rdlr) lr.rn*d 0!*u1x ro rlE co rf,r '3LtcMt w)
<br />,.:""r/--
<br />DECIAAA.IIQ!
<br />I isby .,Iud rn&r Fn lry or Frly or ol rlE folbr h! d..Lr.tinr:
<br />_l hrvc rd sill dirrri, ! Ccrrifsrc olConEnr ro sclf.lnse for sorksr'omFBdion. c pmvid.d for bys<th(:lrcD of0r
<br />L.tc Codc. fr th. p6fm .l tlE wt rtr which rlE Fnn b n{El
<br />Ihrrcrndsrllnrn uin *oitdr'c.nDcn\ on 'nrurrn.c. !\ rcqu,red hy sccr
<br />'on
<br />l7u) of rhc lihtr axb. lor lhc pcrlo Mtre .r
<br />rhc w..I ntr shthlhs Frmir ir tr*n. My*orles con{.nsrio. in\urmccrrfiurl F,ltynumh.rrc
<br />I c.niry
<br />'hd
<br />i. rhc larto,mmc o, tlt *o.l ,m whi(h lhis IE nl k nsu.d, I rh.ll mt cq,loy .ny F's in .n, IuEr
<br />$ N to iEom subi{ nr $c wor*.6 co,{Enurion lqwr ofc,lirornic, Md srrc rhd ifI rlbuld lEcoft iubj€r torh.Mrt6' odtENrion lovtio.s of Sdhn l7fri of E ljb6. CrxL. I r\alL ronhwirh o,flt'ly eirh rtpi prcdrionr
<br />WARNIiiO Fa'ltE '. M *rrt6'eqEdion .oE rg. s unlr,tul .!n {d sbiit - airloF to sinin l Ffllij lrn
<br />cnil fin s u, lo orc nudr.d
<br />'rmur.ri
<br />dollls l$lm.mo), in rd.,itirn ro rlr .oj or coqitrerion. d.msci a\ p,o!n.d for th.
<br />:;:g*;l;r*::o.rn ra
<br />l)l(ll rr[]\
<br />I h.Eby r]Irm u.&, p.Ety of Ftd, lh{ I m lictr!.d !..tr plvltbi of cllrra 9 (o.tmmirs rirll S.ni, 7mO) ol Divkbn l
<br />or rlE aBiffir d PlirsbN Co<k, rirl mr li.r n b tu for rn.fid
<br />toltulllqrolj BlM-AoENcr
<br />I hcEl'y !fltm lnds Fnfllry or Frrury th,l $ft i! a snsrrudion Lndi.8 r8.tuy fo. rrE F o,i,ft. ol rhc srk for qhki rhn rrhir ir
<br />n$cd 1Sa. 109?, Civ. C.)
<br />AIILICAdLTESJEAIIT}i
<br />I MylllhnuDdcr Fnalryof Frjuryon. orrhc rouowing d..l,r ons:
<br />D.tulniin P$nn! ArtFroi lLrirxation Fd.ral Rc8uhrirns (Tnk 10. Pd6)
<br />_R.quiEd lrtrfi or l*rifdid
<br />-l
<br />cdify rh! rlE fqL.rl rc8lbrt ot E8rdiry Bbcnor Ennvd s. ml omlt.bL ro lhn ,roj.t
<br />I ccnilyrhlr I hot rrdthi( Jt'liltr.rkrur, (rrcrhd r)rrh,rc ' I nsrr{ b(unnl} wirhrllC ya' (i,utrr}
<br />orlirrncc\ trd Srrt.lj$s rcbritr8 ri nuiunr! .oh{d.ri'i, uld hci.byrurhori/. rcrr$nhrnc\ orrhi\ cry rnd (i,unryro cnr( uFrn rhc
<br />!dtr
<br />Set Backs
<br />Erection Pads
<br />UFER Ground
<br />Subf loor/VenVlnsulation
<br />Rool Sheathino
<br />Shear Wall
<br />Framino
<br />lnsulation/Energy
<br />Drywall
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certil.
<br />FINAL 6n-<tz ( rC(i 5 PcP)-Lr\
<br />Certificate of Occupan cy
<br />Notes, Bemarks, Etc.
<br />BUILDING. INSPECTOR RECORD
<br />SITE-WORK
<br />Forms/Steel/Holdowns
<br />SLAB Floor
<br />Ext./lnt. Lath
<br />Brown Coat
<br />L.nd.lt A,ldEs: _
<br />il,,; -:;:;:'iK""a=r7,jUg6--
<br />P.mxEEm pdne !t'3ilrona
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