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"' -'�' GI"1'Y Ur' YKIUK L.AK� ii�7�LlliNG Y�:KMl'1', llate Kec'd
� ! � TEMPORARY CERTIFICATE OF ZONIATG COMPLIANCE
" � `� AND UTILI'i'Y CONNECTION PERMIT
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,� "'� � PERNIIT NO. / � — � �
Z P� Gty
3_ Yelbw Apptiqut
CBSC OI � 8t
A �Ll�J'.a�.S �.�l�ll�ll7 (O�iCC usC)
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LEGAL DESCRIPTION (ofl6ce use onty)
LOT BLOCK ADDITIOi�T PID �
OWNER --`"'' ' /
(I�iame) J�' ` ` (Phane)
r
(Address) � � �•tJ C�C� � � �G- /�-c ('
BUII.DER I / � �S� �7��'���C
(CompanyName) Y1t �.__lC.� r�VZt�►Ofi� '�'1C1/� (Phone) !
(Contact Name) � - ' lE? .S (Phone) � — �''�0
(Address) 7 j � '�vi. � e �S �/
TYPE OF WORS. I� �ew c.on�aon pn� pro� �-xo�s� C7�-s�s Clr.o� z.� Fi�n ❑ F��
C]Addition QAthe�aaon Dila7ics
s /�s'.>� ���_
CODE: �I.R.C. �I.B.C. ❑ Misc_ � � �! /�
Type of Co�rion: I II III IV V A B
Occupancy CYmup: A B E F H I M R S U PRUJECT COST/VALUE $/�i ���
Division: 1 2 3 4 S (ex� l�ad)
I nereby oertif'y chat I nave fiuuahed infio�ation on mis appiicaoon whifi is to the be� of my lmowle�ige une ana ao�ct I at� �iy thac I am the o�w�r or autho�zea agenc ror rhe
abave-�a ' and ihai, m�fio� to aII � stace and locat lavos and wili ptoceed in ac�eadanoe with s�mit0od plan5. I am awaze tbat the bw7ding
o' can ffia perm¢ far' I Laeby agree thatthe c�y officia! or a desgoee may eoLa npon the pmpeny to pe�n ns.
x ��.�6 � 7 Z...� 2 � 2
s;gnacure conaaccor's License xo, nate
Pernut Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee S Wateer Met+ex Si�e 5/S"; 1"; $
State Surcharge S Pressu.re Reduc�' $
p�ty $ Sewer/Water Connection Fee # $
Plumbin$ Permit F� � Water Tawer F� # S
Mechanical Permit Fee S Buil�r's Deposit $
Sewer & Water Permii Fee S a�' �
Gas Fireplaoe Permit Fee $ TOTAT, DUE $ • ,'S
Tt�is Applicateon B�o�es Y� � re�c w� �ovea Paid ' Reoei No. ' L
Date .t-- B /
Buil ' �cial Dabe
This is to cecafjr that the �eqnest in ti�e above applicavon and acoompanying docaments is m accadance wrth the Crty Zoning Otdinance aod may prooeed as mquc�oed. This docn�nt
when sigaed by the City Planxter �6es a temparuy Ceitificate of Z�iig oomQlianoe and atloovs crnshuc�on ro o�mmence. B�e occupancp, a Catificate of Oocupancy must be
iss�ted.
Plaoning Diroctor I�oe Spacaat Conditioa4, if �y
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