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� ! � TEMPORARY CERTIFICATE OF 7A1�iING COMPLIANCE
" � `" AND UTILITY CONNECTION PERMIT
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'�'"�` �'` PERMIT NO. /'
Z P�t 6ty /L — v � � CJ
3. YeIlaw Appiicant
CBSC OT � at
ADDRESS ZONING (o�ice use>
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LEGAL DESCRIPTION {office use onty)
LOT BLOCK ADDITION PID �
�3Wl�TER
(Name) (Phone)
(Address) � Z ��
B�.D� (/ � /' •��.� �s� �7d'-�C�c�C
(Company Name) � �'3 ( � �.1 �G� I�t�( OG( ( Y-'�°�7 C1�✓ (Phone)
(Contact Name) �' - ' � '�.S (Phone) �' — �'"�
caaa�s� 1 G �e..u. - e CL SS �'
TYPE OF WORK p New Consa,�ion a� op�, �-�� �-�� a��H � F� o��
C7Aaa�cion pAtteraaoa puc,�' y � r �
CODE: �I.R.C. �I.B.C. ❑ Mic� `
Type of Co�on: I II III IY Y A B r'`
Occapancy Gmap: A B E F H I M 8 S U P'80JECT COST ALUE � �✓ D
Division: 1 2 3 4 5 (eadndi� laad)
I nereby oemey chat I nave fainisbed inf�maflon om this �on a}rid► a w tt� best �my mo�wlea�e uoe ana aoaecc I al�o oaaify mat I am me o�wn� or aatho�aea agenr rnr ctre
above-asen ' pio�etty and thai o�nn to aIl ea�ing staue and b�xt laws and w�ll paoceed ia aocacdame wiih sobmifted plang. I am aware tLat building
official can mis permg �or � r Le�eby ap�ee awt t}� cay offipat as a ac�c ma�r e�a upm tbe r�r m r� �. ��-
X � ��..� 7 Z...� 2 .� �
s;gpat»re conaacco�s License IJo. nate
Permit Valuation Pazk Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee S Water Meter Size 5/8";1"; S
State Surcharge $ pr�sw� ��' $
p��, $ Sew�/Watier Connection Fee # $
Plumbing Peanit Fe� ffi Water Towoer Fee # $
Mechanical Pecmit Fee $ Builder's Dep�it S
Sewer & Water Pe�mit Fee $ Ocbe�' �
Gas FireQlaoe Percnit Fee $ TQTAL DUE �
This ApplicstHon Beco�mes Yo�r � P�t W�taA�nne� Patd C �' Rec�ei No.
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sua ' o�ti«� v�
This B�o catify that the roq�s[ in the above �on apd a000mpanying docuaue�s ia m ac�adanoe with the Crty Z.a�ing Ot3ina� atd may pmoeed as neqoesbad. This docvment
when signed by the Csy Planner a�ees a 6dmpcaary C� of Zoni� a�lia�e and aIlows oo�oc� b ooaom�oe. Bef�e accupancy, a Ce�OfiwOe of Oavpancy must be
issaed.
P�onisg DireAnr I�6e SPecial Conctitio�, if anq
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