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� x TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �
" / `� AND UTILITY CONNECTION PERMIT �' � � ! � � Z'`
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� E 5 ��S
'. W�`e �'e pERMIT NO. i� J ��
2. Pink City
3. Yellow Applicant
Please or ' and si at bottom
ADDRESS ZONING (ot�ice nse)
�S (.� c� c`� � 1J v c, l� ^` c `/
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER �Q f /
(Name) �ci V ( � C�. /� � C.c.� � I 1 (Phone)
(Address) � � C�C� 60 �� Cl� ��/'' ,
BUII.,DER �f� / q ��
(Company Name) /' T ( � � O r/'Dc/ (Phone) L � �� '' . > / �d a(�
(Contact Name) � ( ( '�S � (Phone) 7G .1' vi 7� —a0 7 �r
(Address) ' 6 e � K-�sJ ` ( � f ��
TYPE OF WORKcO'New Construction ❑Deck �Porch -Roofing QRe-Siding �Lower Level Finish ❑ Fireplace
�Addition �Alteration �Utility Coffi on
CODE: ❑I.RC. �I.B.C. ❑ Misc; C �
'I�pe of Constiuction: I II III IV V A B �
Occupancy Group: A B E F H I M R S U PROJECT C /VALUE S v`-' O
Division: 1 2 3 4 5 (ezcluding land)
I hereby certify that I have fumuhed information on tbis applicavon w6ich is m the best of my ]mowledge mre and mrrect I also ce�tify thax I am tlie owner or authorized agent for the
above-mentione and that all co � n will conform to all existing state and local laws a� will proceed in accordance with submitbed plans. I aware the building
official can r e this pernrit for just ca c�e, I agree tha sthe city ot&cial or a designee may enter upo� the property to perform needed ' ' ns.
X ���3?z3z � � �z
Signature Contractrn's License No. ate
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ P�s� R��' $
p��ty $ Sewer/Water Connecrion Fee # $
Plumbing Pernut Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Wat�r Permit Fee $ Other $
Gas Fireplace Pem►it Fee $ TOTAL DiTE $
This Application Becomes You� Bailding Prnmit When Approved pajd ., � R 1 t NO.
Date 7/ B
Buildin Official Date
This is to cerafy that the requcst in the above application and accom�nying documems is in accordance wrth the City Zoning Ordinance and may proceed as mque.4ted. This document
when signed by the City Planner constitutes a temparacy Certificate of Zoning complianoe and allows coastruction to oommence• Befom occupanc7+, a Certificate oF Ocwpancy must be
issued.
Planning Director Date Special Condi6ons if any
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