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/ TEMPORARY CERTIFICATE OF ZONING COMPLIANCO..
p i Q' r
l AND UTILITY CONNECTION PERMIT Ci
kivESO
t.White Ste
Cit PERMIT NO. q /
2. Peak city /�y '�/�/
3. Yellow Applicant `
(Please type or print and sign at bottom)
ADDRESS /4/.2S6— s/y ye. le,ht, 4/E ZONING(office use)
prior L-4 k e-, s s"3 7 2—
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER ,t _
q
(Name) / is rj v e=is g (Phone) q,S A- S 1/0D
(Address) /61,2.6-s-
,2.ss- ,cJV e L- vic- V r,
DER
(Company Name) •4
6/ CM T11 24 arl ,:�T�✓KyV3 (Phone)
QS-0)-f7e Wko
(Contact Name) /�yy
a r 1 1.J L 4 . (Phone) a7,2- €707-1/1/23
(Address) 10,),02 E /111 t s-i, S(A U -e_ ,2\2i_ liZL,?In So Pk) n s7r33
TYPE OF WORK ❑New Construction ❑Deck ❑Porch $Re-Roofing ❑Re-Siding ❑Lower Level Finish 0 Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: DI.R.C. DI.B.C. 0 Misc:
Type of Construction: I II III IV V A B (y���
Occupancy Group: A B E F H I M R SU PROJECT COST/VALUE $ i
Division: 1 2
3 4 5 (excluding land)
I hereby certify that I have furnished information on '"lication which is to the best of my knowledge true and correct I also certify that I am the owner or authorized agent for the
above-mentioned prop ,_d that all construction 'Aronform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can revoke ' .- . for j . .,. Furth .re,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X th ecs 7g60 LI 7/9.Wy
Signature Contractor'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 DUE $
This Application Becomes Your Building Permit When Approved Paid 11 ` J ipt No. /t l
Date s-- z(,/ I - /
Building Official Date
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued.
Planning Director Date Special Conditions,if any
24 hoar notice for all incnertinnc(9521 447.9R50.fax(9521 447.4245