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THIS 11SE VOo BE DESWb9D'AS.
N�iYUTfft)CE�LDG. E OF ONERANG
Q EXIS' dl AIG: a C�ANGE `OF I�SE
Indicate fa' er'fl"se, if'aitiy� ; -� -- Occfpbncy"Gr.
WT1A iE`FT. OFyO D iG TO BE OCCI'AEtJ
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t�J CH1�t`IGE'< F OCCUPANT
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GTICE: 1. OcCt� ' ey,'of an bd i� rs rc�t) f etl'an�i a basil ess �ilcense wlii rift°be'iss ie`tl ifl fil the i
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2. Rio ete`c ical ser ice'`i ill? e - as cl-`for: airy existlh ` I 1'e �' i� ii Service fi'as'beeh i �s� ecteid
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and'ei�itl safe A°ll a)i"`s for �Ccipaay n an eisfi b ITr ire �ecitt tfi sfi I anti`
ele�`is;al :fcase=t' inspectiliiie``Deparf t Sf Delciii'ettServices at "fhe tii`e"flfls
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ing °or°`reil°ises in=irlerptd'deter�iieif ahge`i1�ay=becie in`fiie chareter'of �c`criey or`itse
of fh`e`6 II ii °hi r- �a lses"wl i h w U" lacethe'`b �il�lii' 1� a='dl�f ie`�if �llc�i�io ���fyfhe same gi'o�p`
f �(�CCl1�J cj t5t n a�d(ffere�it `gr i ' f'ocu i0,6" cy,-'a►'ci �r' `e`°6`f166!� �iancy-intoa tlar fee --of `$
shall�bb��l��to��he4+it�i.
N`i�Beach Fl`Ctlie=SectitSh ��. recli�ires ttitbtiltlli'�"ors fittst be rrll
of fo' r (4)'i i�eh�es ib hei t t viiifh dii *6 f�'('%x� hch s r` k , arid'af a cow s 4` `c iior fj``b i e'back-
gro i; Tlfiese' nt� ih rs rri rsti'be` p"o 'e l i yr=if l�ffli^i i i'a i i atitln'thet is Visible froi the sti t.
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6. Nti i' �c "Beath F)i•e `Code Section lb:� rewires fire ekIl"'seer`seleetl ef�ici di
pei'"t11e NatiBii! PIrePr't�efion'A`s;oifiiaFi{lIt #10`Csee r�eierse side).
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WPPLEMENTA"0_0( 'AMATtt'N ZO 1G
PLA`CNECK NO. NO. PAf#1 6,SPAC S
'OCC1tl'ANCY�C#P � _ --
CiC `f �AI�iT GOAD 1 Pt±t`Zi7 T`'46. ____ _ HEALTH OEPT' ApP' 6VAL
I OF STdlftft _ A&Mk ACTION ` UflLl IES RE EASED �---
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C%L.., %cot'�RTiFICA7 O OCCUP'ANCY SEE $ —
DATE CNA dE bF U8E'OR"OCCUPANCY FEE $
APf'1i�O ' E`C)-MW —
�~ TOTAL $ - - —
"` e 7 d .3 L ��Ld•4c .w�.t x,! /S�'t: �j /
/// 7"39'REV• O
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