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�"j `-'-�' Cl'1'Y Ur' YK1UK LAK� KUlLll1N(� Y�KMl'1', llate Kec'd
�/��!� �� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
"`��,'������%�' AND UTILITY CONNECTION PERMIT
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� E S ��S
' W �"` �'� PERMIT NO. /,
z. A� �; v/
3. Yellow Applicant � �''� / �
lease or rint and si at bottom
ADDRESS ZONING (otT'ice use)
� � � ��✓C7 ) '� C'Jc: � r �
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER � ,
(Name) �/�,.�� �j/'� f ''�._ l Q (Phone)
(Address)
BUII.,DER " / � ,. ���'- �! 'S �DO�
(Company Name) � O' r Uc OtJ (Phane) �
(Contact Nam ) � � � . (Phone) �6.� ' .3 7� ' �'� 7 �
(Address) � 7 ���o - �- �.Gt ����- CJ / ���� � �� f �G
TYPE OF WORK ❑ New Construction �Deck �Porch �Re-Roofing �ReSiding �Lower Level Finish ❑ Fireplace
❑Addition DAlteration �Utility Conn on
CODE: �I.R.C. �I.B.C. ❑ Misc: !�'J �� 1 f ��� /�
Type of Constcuction: I II III IV V A B a
Occupancy Gmup: A B E F H I M R S U PROJECT COST/VALUE S� ��v
Division: 1 2 3 4 5 (excluding laud)
I hereby certify that I have furnished information on this applicarion which is m the best of my knowledge true and coaect. I aLso certifjr thai I am the owner ar authorized agent for the
above-mentioned and that all rn will cpnfonn to all existing state and locai laws and will proceed in accordance with submitted plans. I am aware that the building
official can rev permit for just ca . F ore, h agree that r,�e city of&cial or a ee may enter upcm the property to peiform needed inspectio .
X �C 6.��2� 2 2
Signature ' Coniractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DLTE $ '
.
This Application Becomes Yom Boil� Pemut When Approvefl Paid Recei t No.
]�1te B
Buildin Ol�iciai D�te
This is to certify that the request in the above applicatioa and accomQanYinB documenis is in accordance with the City Zoning Ordinance a� may proceed as requested. 'Ihi4 document
when signed by the City PJanner consiitutes a temporary C�ate oF Zoning m�mplianoe and altaws ooncavcdcxi w oomme�e. Befoae occupanty, a Certificate of Occupancy must be
issued.
Ptanning Diredor Date Special Co�itions, if any
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