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SITE.WORK DATE IDiSIG.COMMENTS oWNER BIJILDEN DELCARATION
<br />I tErcby rrlirD u,rlcr Fully ol lErnf, 'hr'
<br />I .m.r.q, tom ltF (iroebd L$ns l,w li,r rtt ai,l!,*ins r.svr ts...?o]r !
<br />8u.fts! .dl Pro,.r*'n CoL) Ar, Ciiy or Couniy *h.h ..ituEr . Fd !, .odel. drd. inlhrE. d.in nh .. qrr ey
<br />nrudu.. rrn b x! r\uB!, .l$ ,cIurcs rlE .t'rl.mr l, su.h Frmr to ,ik r n8rd rrd.tr.r rh, h. or ar 8 ltr.nFtl pws.t
<br />n' rhc !tuvri0ns or E Coneacrr'r l-icnrJ ljw (Ch.fl.r 9. Conmcn.ins,irh Seri,'n,()0O oftivirion I oalh. Burms.nd
<br />Itof.sln C',rL)o. rh.r lr,tr {r s .r.nlPr rlErliom.ii rh. b.rar ntr rtr dL!.d.r.ot,rrn Aiy virLr$.dlsdllD 70.! I J 1,,et
<br />{rli.nr tor. Fm' s6,..k rlE rl'Ihad n,.ov,ltxdlryottur d'F rhr I'r. hoo&cn Jolldr(S5(I))
<br />-1.
<br />a dwrr of rh. ProFny, or my nlPloyer lilh wt8.s a tlEn $t.wpcMlion, wil do llE worl Bl rlE nBiN E @t
<br />ul.ddl orofid.J fn {lc (Sa.?0.4, BurIBs.nd Prsf.rrh^t Co].: TIE Co r&k,'s ti6€ uvd(s N.{rl, h sow or
<br />rlE F{6y wr$ lullt tr ntmE EGa rn *ho &B rlr sit hm€lf d h.elf d ineu3h hs d h.r ov..rt'hy.d,
<br />I'n)vr.lcl rhd rhh 6Fow* e nn nrolal rxofr@j tu qL ll nrws. tll lliljins M lqn,ftnt ! e! rrhroE Fi
<br />o, (.n9lii1iotr th. OvNr Builrtr *i! h.E tr tuLr of F,vuu lh.l lr or dE dil dn ttritl or ir{n,rc lh. F,tEl} ror rrE l,u4n* ol
<br />_1, as.*rr ol fi. !n)Fny. rm .r.lunrcty Nnr.crd3 p( h lkcn*l r.nrkr.6 n, (!n(n{ rlr F,Fl (Se 1)44, Iruws
<br />ur PDt$r'n Grdc: Thc O,ntrrLkx s Li.ctrs.l-r! ddr nol.Fply kr.no*n.r.l t'n,Fny wh,buildr or mlhvcs rh...on,
<br />t.d vh, NNn(k ntr rlcli !fl,Ft e h r ci,orftt,(r) lr.nkl puFu, 6ilEcl, ren{i Littrs lrr)
<br />-!
<br />amctcnpr u jcr S(rx)
<br />lloxf,lxltaufasau(rti
<br />IEO.ABAIIq!
<br />Lf,rchyu,litrrn J.r |lnrlryol Frttrry onc ol rh. nnlo*'n! Jr(laBrnr:
<br />I h.r ui will trd.D r cdr'r.r. of cdsr b s.ll,lNw ,r{ krt6 .r'IYrrrnn. r ll\,rddj lq hy sdlrn l?m of rh.
<br />lln{ Grj.. l{ llE F.l.'M or rh eorr tu *nich rlt Frmir a *ocJ.
<br />d hrt $J will dinr.D *orl.rt cohFBdr Bur.m., .r rcqurd by S.Lrkrn 1r@ ol rh. ubor Cd.. lor rh. Fi(xNB..I
<br />E qrl lq rni.[ lhn Fmir it srEI M] wrt6' rup.db. rmrmr {r 4rl !na, ru!$6 &:
<br />LD t-{ c
<br />A(LuJ q( lq I ?( I LI
<br />./I' c.n nr rhil r rh. NrlortuNc o, rhc uork ttr whiuh rhir lcrn n ssucd,I {lrll nol cmtl,y .ny Fr*r h rny m.nk.
<br />r' .s lo tE!.m subFr k' thc w,rtc*' con{rnurun lawt ol Cd otu, .hJ r3d rhr i, I rh'ulll lrtotu shFr b rh.
<br />krd6' onqrBrrr I'ovEi'tr\ .l SalDn l?m rt tE LlEx OrJ.. t rldl tudhs h !-n{iy * h rhoc |rov$nn.
<br />WALNING: F$luc ro E*r *ffi..r' .nmrEn{'in Lws. !s unL*rul .r rhd $t'rrl .n .htloFr lo .:lfurl IrMltB {rl
<br />(,vil nncr ut h onc huD.lral rhod:md dollm (5100.On), in rdJiri,|n 1,, thc co$ ol .onncnrltn4 .nMscs .s t|n)vidal tu rh.
<br />sNrrrn rlrT6ol rhc Lahtrcul.. d.r.! anJrnonry's I.r\
<br />o",,, L)tall I
<br />Fnrlt o' Frlury rtur l:n,uDL tFvlrr ICh.F€erNllffihi * h S(r!r ?OfiJr ol Ddtrbi !
<br />or rh. Buift* .il h,t snms Ciir., !n my lx.ns s m liill fo^! rnl cddr
<br />klo
<br />LI
<br />I h(Et'y.l,jrmundcr Fn.llyorFr,!ry
<br />r\ucd (Sc(..1(,9?, Crv. C )
<br />nnnrknr ktrJtru rtcft y,,r rhc p. !trnu . ol ihr vtrl ntr *h'!h rh^ Frnnr N
<br />afrltcaNflEcltSduoli
<br />I hsdry rifm unJd Fnrhyof FrNr! oE ol rh.l'nI,o*'na lE-,&rr,nr
<br />D.mnirirn l'cnhik,Arh.(ot NorrlKrri,tr tjcl.rrlRc3ulctkrtr! (Titlc4r), Pan6)
<br />Rc'i!r.d lltur {r tit{trrrLh
<br />>?..nrly rlurrh.lcJdJrcSUhrtrrB rclml'it db.ros n'valartroraml'.rhl.n,rhNn'rr.r
<br />=l
<br />cdlfy
<br />'hrr
<br />I hlw Eal rhr.t4lrrrir rn ri.r. rlBr rlr.tnt. irnrlmrm n lrEer I .eE t, $q'1,, h.ll C y.rl Cou.ryo iDEs rnJ Sr.l. Llw. ELl!\r lo horldnS connulon, .,rl tErcby .urhtrr. Rlr.rnr,hv.s or rhrs cny rnr Counry ftr drd uF!. rli
<br />rbtNc k-n,tr,mJ pr,Fny r(tr msr4${'
<br />t 1,, /,,Appliont o. ,\s.nl SisuluE
<br />d
<br />Set Backs
<br />Forms/Steel/Holdowns ffI :Z-t.-7,!. )H1l c.t€ t FrL
<br />Erection Pads
<br />UFER Ground tPlJ'
<br />SLAB Floor
<br />Subf loor/VenVl nsulation
<br />Roof Shealhing
<br />Shear Wall
<br />Framinq
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coal
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Reporl
<br />FINAL lz- (-r(,NU6 nl
<br />Certilicate of Occupancy
<br />Notes, Bemarks Etc.2-22-t wl .,dll-3--z ; Fi6 F't n!4&u^^14-)jlL .rt t.0
<br />0k a 'to E P a &/pL 41 F-L fi-t/ i1- e i'
<br />BUILDING. INSPECTOR RECORD
<br />.?.:.7
<br />Flood Zone Certif .
<br />81Zt I
<br />I
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