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c-EnflPICAT5OF-OddOM CY
CITY or_fj()NTINGT.IjIN'8EAdH Date
�Mtwt SF_R
0 MEW OF'DEVttO
r
VICES
11UNTkow.4 MAC"
'Addeess TO.
Blislijest- ame
"9W`fih6ss Type
OWN EA/NI�AAGE
.jgCDjt4 OWNER
Name
N olhe,
Addeess -
Address Tel.
City
-------------------
Cfty nk_'Idr6 d
i0q oa(L—
Ccins��it tiara --No. t)(9t,6r:
DEPARTMENT OF -DE'VtCOPMI�UT'
This CSW166of ecupaiicy
SO, s
S ALI 0.
place ort
. .. . , ... shell V,dVXddpt by
e
of-
1: PIT T�vl(
f
'CER 0 p
AP0Li6ffb_W A' ty
�Aj U 4 �1U pm *%, -- .0,,, & 4VM44&1� AA h Depart ►eTwbt Devel -aent 5-irvices
T-
PPLICANT T ribt or tyre"On Y*
--
FOR A 0 rlu IN DATE
Application is -hereby made for a Ceftifilqate of Occupdhcy for a:
(0 L, eq 7'1 /)-L cit.. Div.
Describe Bus Ue`ss Use
To be, klib Win 6 s
Name -of [BUMb6ts
Located at 0 i
rus,iiiess Address
A
�y
Retl*AMO'Address zip
Phho No.
Name.- B�USESS OWNER I
3L
-Ms%-Oss: Resi'ddft'6: c") 6 ,3 c,A
A
Phofie
Ab-, BUILDING`OWNER Nddress city
T 0S`F-W6Vb`9`E bE`S`_<__bE'b AS:
6ildi-hg wher
FVI Oe of '0 i'
f -1 N 6W, 1 y C &S, t ft cd t e d Ch6h f
1ffExi'sdWB dil'dth Ch6hge o. f Use Ad"di't
l6hal Occtl�dlit
hai Cate f 6p use if any Gr. biv.
.NOTICETS tahtyOf a`y--'-A2M'is W%it'6d,andaUsjfess j ddht e Vi.j 66t be jtnba
0fil thbltfildlll�has b06iJh§p6cteda'W'd �a Certifichte 'of Oftup -Ky �is ISSURV
C e V c 2. N0 6 ffsi, cal s 1� Hli` e, -Wi 11 be released f6r4hy,6ki§t-i4'.",8V
e certifi d s AT f0_110c- 6y
S0 Ce has 'been ih9pec-'t`-Fd--a6d e aft. I a0plil-
'60�dd to sdhOdMe ah-eld" �,Fi 0
b0i'Td- are e - ro-q
in 6h, ----e k i s C
I --- p - `*fty '06V-16 Mt a t
i �4 I I the -f ft
ipsl0ecti-61h!-in the ��Ddl 0&66t of B'di I d 1 #6 i and - c 61
t tt� �is i-11 O'd.
0
,13. INSPECTI �T t. -WhdhidVer 1- is h, e c e- s-- s SW t
ty
C-4 6E.OF OC - .0 9•M : � mike
ne, 1 a- ch vv-,m4�y
f
i k ec i a bu i d i;hO 4r:10fti s`6S in l'dlkd6'r to..doterMj
remises WH- Ali'
, " 1-0,0, . v�,
M '6t& -" -occ ah'6 f the b6ill'
be�, Me in 0. CY , Ir use
ffilt -hzg th a i f 6rioft �' i is
J. ' iz d`V- �i6t-+' f -if e czame'�O'Yft
Mil-ld Cie the 6" �g 4of 6 i� d' U 0 a h 6Y
M.01. "fee 6f
0"'My A e b t'i
ar T - a �di f f 'r6 t o c 6 Oaffity a chaOe� -of -occb a
$80shall be pM-d'4`tb the City.
(F6A:OtFlC'E `USE `ONLY)
Sq f tof .. ,Plan CK66k'-Nb.
.QC, dup6liby Grobp_ Per iiii`t No .
0,60ht Load AdM*. Action
C hl�l
No. of Stbries
'No. 'Parkib' Spaces
d Health Dept. hpo`oval
Uti -1 "tto's Relo6ted MPROVED BY -DATE CERTIFICATE OF �`O _6 CUANCY, E'EN $
CHANGE OF kC0000 OR USE MSPE&JOWFET
TOTAL -V
, (05"0