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� ti+s is ►'ce lift' th t t1�e... 3S atitl OH*
tlt�der tlt it lllti f't`Fri�it Vt�.._ __ _ arid i� itfet �tif�t ci rS ► >�t St t� "Huhtivi tali
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and zto ideifi i! itli it tii J. C
6ri`the l i lifm`q owned try Sutnftjga _ _ ,l 'twin it, , lu tihat6w beach,
Warne address
C �►rr�ia rorrif�lies will) the °prbvisioiis bf all°'pa~rtiitt!h awS,`r,mlf!", ofdihmlces ,'trot afl*v E+►r►St�fE�tf
�6141 tio' ns for 146110 described acid ri,t Wiol as an F"a � tscCt�pari�y.
MAt 11iV1 OC PANT LOAD P�� ArtlTT1=17 4
i rVolTre
tkis Cep 1 Whtt3 of Occ pArt y ,Jdhn F. B1) s .
SMA'CL BIE postedIn a c'onsr)}cttes ptjc;,t on
Miectoe of Eitii[�iirirj"!v"Gdmrr+.,miry Cln�air�pnter.t
dh� j3re'liiises and hail not tie teiii`t5VC-d except 1
by. the f3u0di4 By
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APpLI TtOW `CI RTI `ICA`tF .�F OCC tp IiCY
%t bf Nunti on 04dh _ �v�:Depar�t�6t of f3U11r�ln D ►tr [ ii ty Deyblq edht
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FOR r i 1GaNY 'CO t Itwl 'ilk tPrintor type �n1Y}}� DATE
pp da°tion is her6by made for•' a 'CertiMCA- e of-occuoAncy for a: y
DeWibe Business 'Use
To °be ki o to Ss ,j L l�..� .J
- � Name,
Ds� ess
ins hbSS d' ress
a e; motes i deuce 0 6ss P
'phone No. BUS ibo*S Resid nCe: _ ..,..
me• Y i i�S ONE
a y ;p
*THIS �U EAdi �D-: BE DESCAz QED ' AS
� t r1y Const► u�ctetl' BUi l d i ng' �`hbnge of Owner h'M1§0 of:. Oc+c�l�i� l t
ExistirS Btiildi Cli' i'e of "else Ad f'tional Odo ht
g
Ih, -dat"e f(ii*6 use if oy _ - �oct� cy�Gr�. Div.
# F
deiiiia loy .o any u rig s rib t `a` i s �nes "eft T ►� e�issUe
r _ .�
. ti l .,the titii i' ii g' =h s been e ted i d` a Certi f i sate ofi ,b d-OpWky .i s i stUd
`2, "flew el+e'ici Se vice will b+ te'leaseti fdr air a>iSt1"t biift'h`il the
ser�vido `has been inspect 'd air! cor{ti fiotl safe. All appl iea is zfo�r iu cy
in
alt -i`ii�g�bultlfrig arereq"i,eriioschol�ilean °electiie:
:. «tg _a ,
inspection in the `De artm�r t' `%f I3rlild�rl and ° ;omni `i"ty D PI60k t at 't ie 0
s icati6h is filed.
3. Oft 6r 000P-ANCY OR USE I 01EC1'IUN 'Ft u . Whei ' 00 1 t is nedess ry to make
irtsPOC =16,h of a b►si l dinq -dr h�emi es in ot�der to �dete�mi e i f 'a c�h' e may
a.
be made in the chi acter';of bcd p '-Cy `or A!se of fife � ildi�g �remi��es With
61 1d,#lake `the bu 1ding in a diM-woft d�visioi `of the sate i e p of
er 1Ii a tli.ffereot group c t pccupar�cy, `a cha e i�f-oCodpa cy i ' `tio i fee o
25:° shall'be paid t� the City.
(FOW "OFF CF USE `divLY
sub Mt At IN�o�r� ild
S ft, a# Wi¢ld:il �, flan Check No.
4cc `dy` Gr6bo ---- �,, Permf t. No
t5ce 't Load' _ _ , Admi n . Action
. f t i'es _ �_ No Favki ng Slia�es�---
` 'Nea l ti1 Dept . Approval
'' ___ _ •. jr Utilities i e7ec�sed
p .D B,
r. D T f
CERTtF 1CATE aF Of.CA1C�f �'EF ` S:pgD
CHANGF OF 'OCC" PANCY` GR USE I �S FCTi N FCC