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"'� C;l'1'Y Ur' YKlUK LAK� 13UlLll1N(T Y�KMl'1', llate lZec'd
ti '' �� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
"��� �'� /`� AND UTILITY CONNECTION PERMIT �"� 2��Z
�
� E 5 ��
' W '"" � PERMIT NO.
2. Pink City / � . � � �
3. Yellow Applicant
lease or ' and s' at bottom
ADDRESS ZONING (otrice use)
C�S' � ! c� � c�tc. v�c'
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) �G�.tn..� Q,( (� l� e...S (Phone) Z' 7� �Oo�'Z �
(Address) �,,�` 6( oo G�G t� U�
BUII,DER �C.-' �,C,3 �G`�'C�T(O� G-�t� � S 3 Z� S�d Q
(Company Name) �'/� (Phone)
(Contact lvame) �.cJV�_ �'� ^ �� �S !D < �. (Phone) 76 3�3 7c� --c9� Z �
(Address) � 73 c6 � d ,�� ���3
TYPE OF WORK ❑ New Construction �Dedc QPorch �Re-Roofing OReSiding �Lower Level Finish ❑ Fireplace
�Addition �Alheiation �Ut�7ity Cannection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misr: Y' ,S� � 9
Type of Constroction: I II III IV v A B
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE S�/�
Division: i 2 3 4 5 (eacluding 1�1)
I hereby certify d�ai I have fiunished information on thig application wLich is to the be� of my lmoavled� mre and mrrect. I also certify that I am ffie owner or autharized agent for the
above-mentioaed pmperty and that all �uction wll conform to all existing state and local laws a� will proceed in accordance with submitred plans. I am awaze that the building
official can revoke ' ' for just cause. I tUat the c8y offuial or a desigoee may eater upon t�e propeity to perfo�m needed ' �pections
x �_� �- � 3 7 Z 3 z. Z6 2
Signature Contractor's License No. ate
Permit Valuation Park Support Fee . # $
Pernrit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ Pressure Redu�' S
p��ty $ Sewer/Water Connedion Fee # $
Plumbing Pernut Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Othei' $
Gas Fireplace Permit F� S TOTAL DUE $
TLis Application Becames Yatr Bm'tdiag Pe�it When Approved paid R t No.
Date ., , ( B �
Buiidin �cial Date
This is to certify that the reque� in the above application and accompanying documenis is in accorda�e with the City Zonmg Ordinance a� may proceed as �uested. Tl� document
when signed by the Ciry PJanner constitutes a tempoiary Certifificabe of Zoning c�mpiiance and allaws co�nuction to �m�e. Be�ne oocupancy, a Certificate of Occupaacy must be
issued.
Planning Directq Date Special Condid�s, if any
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