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-APPt. I CAT IN FUR - CFRT I F I CATS -OF - OCCLIV49CY
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F R APPL C. ANT TO FILL IN tPlint or type only) t1ATE
°Aplieatioii "is hereby made for a Certificate of Occupancy fora:
Occupancy_
Describe Business Use7��T-+--
To'be -known as_'_
Na,____me Tf Business . Ad,(Q
Located at 7 :<•. f� t �:c�
i ,
Business '7CTttfress
�* cy, �? v['t-,,�-,��<• ►� �` �� '-' /
Name: U l O64-1R — Residence ?address City Zip
Phone No. - Business: Residence:
Name:
TIRS USE WOULD BE DESCRIBED AS:
[=j Newly Constructed Building
ij�] Existing Building
Iridieate former use if any _.___
(?Change of Owner ,] Change of Occupak
{_- Change of Use Additional Occupant
Occupaticy-:_tlr . Div
fl"IU-��:`Y�`ccupanc a any �iu� Groh b�tea
ancT'a business icense ilT' of �sSAl
untilthe building has been
inspected And
a Certificate of Orculi7ncy ;is Issutd.
2.
No electric::; service will
be released for
any existing building until the
service has been inspected
and certified
safe. All applicants for -occupancy
/go
in an existing building are
relui►-ed to
schedule an electrical "fuse up"
"-
inspection in the Department
of Building
and Conmunity Development at the time
".
this application is filed.
3.
CHANGE_ OF OCCUPANCY OR USE
INSPECTION FEE.
Whenever it is necessary to make
inspection of a building or
premises in
order to determine if a chalige may
AV -
be made in the character of
occupancy or
use of the building or premises which
would place the building in
a different
division of the same group of occupancy
or in a different group of
occupancy, a
change of C-? a .y inspection fee of
?
�►�37k
S25.00 shall be paid to the
City.
f^
°- ' Y
_ __ _ _-__-__- --_�-----_---------__�_�
-_-_ ___.____
(FOR OFFICE USE ONLY)
SUPPLEMENTAL INFORMATION
Sq. ft. of building_ __ __t t• _ _ _ Plan Check. No.
Permit No.
Occupancy Group_. Occupant Load Admin. Action
No. of Stories No. Parkins: 5 aces
krealth Dept. Approval
V*� UtiI hies Released
CEtit,F1CATL OF OCCUPANCY FLf ; S:Ou
CHANGE OF OCCUPANCY CAR USE It:SPECTION Ff_t
(#75-039) _