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�� r �'���. `�� TEMPORARY CERTIFICATE OF ZO1vING COMPLIANCE
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�.r`f �? �„��" AND UTILITY CONNECTION PERNIIT
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1- "�"` �'` PERMIT NO.
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3_ Ydlow Appliont
@�SC OT �d �t �i(NI�DM
ADDRESS ZONING (o�ice use)
Z I.S c/�✓� C� �� �-- �'L .S
LEGAL DESC1tIPTION (o�'xce use oniy)
LOT BLOCK ADDITION PID
OWNER ^� � �% /
(Name) � 1 2 � S /J � I�r/ �°( l� �-L1 � (Phone}
(AdaresS) �. �.S �.� (.t� f ` ��f c i��
�..D� � � �' "�:� js� �7�-.S�G��
(Company Name) 7=,t �,��/Cr �S �G t�i�► �(/j ( J''�'27 C1�✓ (Pho�}
(Contact Name) �- � � (Phone) E� '- �"�
cA�� 7 16 e-�. e �
TYrE oF woR� � N� co� p� Q�� �-� D�.ssa� o� � F�• ❑ F�
�Aadidion �Aloeration �vn7ic�
CODE: �I.B.C. �LB,C. ❑ Mis� � � �-� "`� � ��� �
Type of Constcuct�ton I II III IY Y A B
pccnpaacy Gra�; A B E F H I M g S U PB.OJECT COST/VALUE S �l �� �
Division; 1 2 3 4 5 (�� ��
I herebp c�►tity waz I ha�re fi�m�d io�alion on this appli�ation � is �o the best of my Imowle� tcae a�l � I aLvo c�od'Y �t I un aae owner or ann►orized agenc f� tlbe
above-men ' and that mo6nrm bo att e�virg �ate and lord! ffivvs aod wH! pdocced in amocdance with sffim�ed Plans. I am arvaze that the bui�iag
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of&cial can thi4 pecmit fioa� � I hereby ag�ee that the city official oi a de�nee may e�er apon the piopaty LD pe� needcd -
oa
X �G6 �7Z._.� 2 �a �Z
s� Contra�oa�s Laoense No.
Permit Valuaxion Park Sapport F� # $
Permit Fee $ SAC # $
Plan Check Fee S Water Meter Size 5/8"; 1"; S
State Surcharge $ P� �� $
Penalty E SewerlWat� Conn�ectian Fee # $
Plumbing Pernut Fee S Water Tawer Fee # $
Mechanicat Permit Fee $ Buildei's Deposit $
Sewer & Water Permit Fee $ ��� a
Gas Fireplace Permit Fee $ TOTAL DLJE � , S
This Applicaoion seuomGS Yo� � Peeo�c wLea Appro�+o� Paid Reoei o.
D&te B
Buildin Official 1�
This is bo certify that f� requcat in the above appli�n aud aam�aay�g documems is in xmcdance widt Ux City Zoning Qrdio�ee and may Ixooeed as requesred Thffi document
when signed by the City Planae� con�itatcs a tempoaacy Ceiti6mte of Zoain& a�pliaaoe and ai�ows coa�cucaon w oommenoe. Bef+oa�e oocupancg, a Ce�te of Oocapancy must be
i�sued.
Planning Di�e�a 1� Specia( Conditiaos, �' any
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