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t� thr�`�uiwh gi a final. BY
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Name 'of t3tis i Hess
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fame AOttl5YNu 6%M8R Address City 7i� rilttl�e Nb.
Y �kS USE `;-q6 fA) BE DtsCRI'P4,0 115:
4641.y Constructed i3�.Ii:1'dirig ��'TCharige of Owner � Chnnr�(I of t�ccul�ai t
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Buildi-n r, cif UAdd{ I C�ccu ,ant
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ii::— former use ,-r cony
.---=�—, � FesictcirYce Address - _........_.._._ • Ci t __:...�..�.._�.._.. r
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1TAMe . 'AtIsi sS '6wNrER
Phone No. -- Suijinoss : Residence
NOTICR: -'1: Oc-cupz-incJ oL any bttil`d3nc� is' prop"ibi.tr�d and 7 fiiisihoss 1.i.cenac gill not be
i:ss(leci` utit.i l thy: btii'lciitti`c1 `bras bec t3 inripe" ed acid a Cei-ti fict-rt e ' of Occilt)t5lCy
d
f.s isgiled.`
`el.ectric��l. sc =vice wi 11 k e released far. A5 `e ist~iiit� YjtAI'dtliq until l ftr�
service ha �° hers ihApected and cc't'ti fled safe. A11 'Applic:abt:s fear"occupy-dy
in yin xi tittg i)l ildihq are re ii.i-ec3 to ` cht ti&C, Ft11 elect rical "Fuse `ut)"
;� . i:nspectiorz i.n the DepaYtmerit of Suildihq and Com "Mi ty DP'I e01014Adnt lit. c:1i6 �
h� time Lhis applIcat: on is "filed.
% 13. Of GE OF OCCOMNC).' " Cin USF. rN08' CTTON FLE . t#hftnwer i t is fiece:�sa� y ` t a fr:ake
Inspection of a'- xA ldi riq or Oi6mi yes ill 'OYder. to 'dcito�itifii)"c i- f a c hangc� may
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be mete `iri r he ChE1L c`ic.ter. of ° occtit �i;ice} c7r "Ilse ref .lie katy 1'l ri i n `oz rarer.:laces
'which would'-IAiace the buildifig in -a differef. t di.vision 0f. t'`l e sumo giailii of: j
-occupancy, or in a Ai f fercflt cLottp o"f occiit?ahcy, i chatirto riC ocrlipi"sxcy
inspection fen rf Y2. DD sheill be :Pa (i to tr2i"n Cit'y.
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Si PLEt9NTAL I NF'ORI-IATS. To �
S . ft. -cif.,buiAding. Pir-in Oheck No.
Oc►tiparicy Groti-) -- - I�c+t-i�.it 'NU Z77V___
Occ tpa t Load _ -' -__�_ _..__._ Admin. Action
1 Spaces
f Y "'ri s�
rIo . I � r. ri
ti e.�
'No' `o S i� e 9 P
Heal i h n q t_ Approval
iliti.es Ikelc�hseci�
`Aff 1R IE BY V MTV
CEtITI FICA'IT17 OF CX'CtlPANCY PEE 5.00
(ski 5=03n) CttAtyGE Oi, OCCUPANCY 0R. U..,,E ` INSPF:C1I110M FEL _.__..�.�
TOTAL