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SITE.WORK DATE ID/SIG.COMMENTS OI{NEN BUTLDET DEL(TR TION
<br />I h.Elry ar,n u,l&r FMhy or Friury rh{ I m .rcnlpl nDm E cl,nkdN' Lt.tre Lw ror dE followinS E.$n ls.c.7oll 5
<br />Burin.$ $d Profcssirn C.dc): Any Cny or Cru.ry wntn EquiEr r IEmil to .onnnd. !lrs. imprDE &nnnh or EFir e,
<br />srncnrc. prbr ro irr icsluc. lko Equircs rhc lplltdr lor slch Frn ro nb. si8tud nrEmfl ihx h.6r sn n li.cn*d pNrnr
<br />lo rh. ntuvrioff of tlE CoMrrols Lt.nEd l,! lchcpls 9, ColtwEinS *ilh Sdion 70m of Divisbh 3 ol ltt BusiE$ ud
<br />Pn'rcsioni Co&) r Inrl h. m {E i'.rrnpr rhsdn,n.id rt brii ror rlE rlLr.n.!.n!r.n Any virLrbnorsdhn 70115 bro,
<br />+pli..dfor.paniohFrtrrE.pplic. ro . crvil FMly of mr dre rh& Iiv. hudr.r, &llar ( u00).
<br />l.( owof rlE pnrFny, s d,.,ph)Er B h p.8n a,En $!.nn{rNlbr. will & E! t{n|lE:ldlE k ml
<br />inrc .d or oficEd lor gL (Se.7044, BBiE$ ud horcasiotu Cod.: Th. Conln.lo/i Ii. { LI* &4 .d +pl, tb @ o*ft, or
<br />rhc,r'IEny {ts ttrildr or iirruw rh.M[ und wb .nx. sEh rDrk himr.lf or h.rslf or lhmu3h hn or h.r o*n cn rLy.ci.
<br />provil.d rhrr sEh nqr.Ec s4mri lrd dollrd ior sh tlb$.w.th.t ildina o. in{mrr iss'ld*ahnomFr
<br />oloqtlaG dE O*rr Blitb EiU hrE tll h!j6 olptuvirB rhc ll tE dn d hrild d inF)E 0E FoFry,br tlE Frpo* of
<br />L I o$Er ofrlE fhFny, lncklusiwlr..drdo8 *nh lt. <d.odrr(E ro tud{Ri rlE F,F< (Sc 7OL, Butls
<br />n., hDGsir C.d. Th. C-o.trrrols Liccnr l,* &Er mr apply k, u o*oo or prcp.ny *ho hild! or irptuws lndm.,
<br />lnd qho .onlBd3 nn ruch lmlcns vilh d a.nrrub(n ltcn*n J,usunr h rtE Clnlru(lfi! Li.rns Liw).
<br />O,r.
<br />*
<br />[ll Uli(IJB,.Ill9:
<br />I hrr.bJ_ xrTtmund.r p{rh, of p{ru' r. otu dfrh. i'll'sin! Jc.lIari{nx
<br />llv.rM*illnudrinx(rnill.rrcolCo\.trrn,S.ll l'r\urcfn*o'1.'r'(nnp(t\ltot.r\ p(,!klcd br hyS..ri(r r7(X)ofrhc
<br />I]htr ( irh. nn rh. F-rloniun.c of rhc *orl rr qh'.h rh( nmnir N \\u.J
<br />-l hrE .nd *ill minl.in *0'16 onp.rsni'n in@E., Etuir.d 5y sGrirn.lTm or rlE Ltbr c6&, fd rtE Ffffi ol
<br />rlE q ror whrh ihn Frnir i! no.d My wo.t6 $n .Mirn imt&r 6iT .nl Jrli.y numbq c:
<br />-l
<br />Nnily lh.l in llE rErlormr€ of llE vort fc whth 'ht Frmi ir nru.d. I dEll mr crmt t.ny Fetr i, rny tur
<br />5 6 ro lrdc srbiir to rlE hrtd 6tr9cdi.,n L*r or Crrifomi $d .pr rhd ir I lbuB ha{m $bFl t. tlr
<br />h*6 $nq.ndb. pturlrid\ or Sdto. !7@ of 'll bhd Cod.. ! rlil rdhwnh 6rply uh tho. Flviri,NW^lNllrc: FdlE
<br />'o
<br />suE srlm cor{Etrdio. 6wn8. n ln6stuI .,n s!El! subFct o mploylr lo aini l Frlis rd
<br />.,vil in r up io on hu.dr.d ihoue.d dollsr (tlm.mo), in lddirn'n b th. cosl ol cor{E.r.lion, dlBs.t B In)vn.{ for lh.
<br />I2 TLJITIII!]:
<br />I hc.dt,.rtrm u,rdcr F h, or Frrury rh.r I m lirB.d ordcr Fevni,n oacn pr69(6.1llftin8 wirhsdi,n 7m)of Divtion J
<br />of lh. BNi,B trd Pof.ituN tu ..d ny li..k ii h tull loc.d.fi..l.
<br />LiaMNun*Er
<br />Conlrrctor
<br />C!]!S[8!qIIQB.IEd!IMGE
<br />I hcEb, lmnn undcr lEnrh, ol Frj!ry lhlr lhcrc n r conslruclion kndinS o8.my for rhc pclumrcc ol thc *orl fo, *hich lhis Fsni ir
<br />issu.d rsft.1097. civ. c.)
<br />APPI ICANT nECl 4IL,\TION
<br />ItrNhrnrlntrrutrdcrpctr!lryol ff,!uryoncol(hcf(nl',f,rn8d.cl 0rn,n!:
<br />t!trrnni,)n Pcrmir\ Air( \ Nolili.alion lirlcrrlR.3ubrn,ns (Tirl. {).l'for
<br />R.qx"crl Irrrcr or Ni,li.rr$n
<br />-l
<br />cdify th4{!: fcd.r.l ErlLrhN E8idiry r4.{o! Emr.l e rn lpl,lirblc io rht ljor.r
<br />I c.nify rhat I havc Ed rh! dnplic.rion dri nrr. rhlr rhc abovc iorondion h.otu.l lgB tlmnplysith rll Cnylnd Counly
<br />oidi..r.l !d SLtu rrw. eLrLA ro builling coBrru.lioL .rd h.r.by Mlbrn F,msnl4iwr of lhk Cily llld Cornly k' .nl6 upotr tlE
<br />ltnv. aE.tiorcd nmFny nn inrpcdion
<br />Appln ml o. ,\A.nl SiABlo -,.=(/yk
<br />Set Backs
<br />Formsi Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsulation
<br />Roof Sheathino
<br />Shear Wall
<br />Framino
<br />lnsulation/E nergy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />It/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif .
<br />FINAL v34/,Z //2.4 ,.r4oJ>--2ry
<br />Certilicate oI Occupancy
<br />Notes, Remarks, Etc
<br />BUILDING. INSPECTOB RECORD
<br />:::'_ 4 t lt,
<br />t nLil Ad&6i:
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