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OM FANCY
CITY tFt7t1i�'INGT(i11 l3�ACH#.
'boo TMi~a Ji d�F [3C�Ik:I T G &'COMitillUl i`TY DEVi='t-'OPM'WT )ati;
UNTI'SflrlN kt lAtli -
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This is to acrtify tttat ' f he
as atftW6'ii
� '►arsd-is tf
t4 tttr.r Idi F�ehni'ii-Nip. `rl `tif as
tied
a.;• . .. ,,.. kfdrQss
a
-111XiJlAI1.=i8i1__ : ,and°`dr:5crilit as 1�$_�f�..
ttie"t�tiii`rtii"g owiietl byTh
ti3.SLfD31 atQLI'i11X_._�:
��nrtta address
wi is thc� pravisiiins of aII fieftinent `�a�ivs. r.�it�cs, i if ti nc�s an d any i'j i o i
��c i diti ns far tlit2"IISr.� described find ciasa as an ______ +'_«� ___ oCr�ttj)ailey.
fiiA>6M, OM,OCC(j'P4 T.-LOAQ PERW41-TE b._ :_ � _ 0_.
��rca trr�.•
Ceetii"fate Hof ` ecupa6ty JBhti�F. 6etire`rts
HALL BE'iitisted in a' conSpkLinus 61kP 'ah -
Director of B�riidirtg & Cr)mrtt.artiiy bevQibt�rnrt
tt,e:iirert4,sea and 5h0fl 1 tit br, rertiovuu (!Xuu t
by ib4 B611 liiluGffrcint.
L I "OR 'CPMTIFTC'Arrul, OF octtj[I Amcy
r -.i�o r. e6ch
0— E6 Y opa t nit. of t� k Hyjt� c Onity!'De I
I.tY, L. ti
'(Prii
FV) R APPLICAW"'PO li-T:L!, N ht 0
fit
-h6y f
.iicactidn is. hereb, -,made for a Certificate of� Oc6tipa or A
17
h Describe. Bii�OJ est Use
41 OA/
Name oB6f, s i I I
ed Zl t lx)ca
v -b e s Addr ^1 r) s fit;;,..,
SIS
B01 DING (71 ER 'oss W6he 'Na.
Addr city
U'
TF.Ic USE WO t D 13E DES T EV AS:
c
-Y --tedtbildilM,
-Newl' Cohstr�b Chanqe of 0%41,lor n(16 of Occupant
A
Existing Building dhhngeof us-e F-1 7ddft:,io,n 1 occupa'nt
Indicate fou rmer se ifany
lil, w
LCA iXi
0 Address city zip
-SS� *NtR R68iacc! A
Name: BUSTRE
Phone- BUM ) 3
6
2q w
Reside»cr...
'Upa' c_ Y of any b(ii-Ifthq bi t ed an w p, 61 us, i h e s '1Ac(*'j-;e will no -
NOTICE: 0 S r i i d a t-be
issued .dhtil the building ,has been inspected and a Oertirici4te of Occupahcy
is issued.
eledtexist3A g 'l -Nt4kical service- 'released for any dVng buIldifi' U n - tl the 2.
vice has L-e6n `'inspected acid certified s' fo. applicaht 0 6 �ancy a f C06�'.
b ding
AR ail.. xis ing -)re41aired :to schedule an 'I tkical filbe b e " t * Al are''
jW*t)o6H.on in the Depart e"fit. of 8 b i 1 d iin' g and Cot bility T) c V at 1' h e-
opift(int
tWine t hi. ap,p I f c-, a t ion i s I I ek.
Q0
3. TNGE (jv OcdbPARCY OR lbSt ECTION FEE. When Veii It A�, necessary to make
P x 61he if a dha'nqe may
=f_16n of a -builditig or 'r mises �':Un- order` d 'te `ii
he character "f: ocolipzincy or,use of "Elle bUi1'&hcj or premises
e, in 't dt6 0
place ti. tfer6WL d'i 'isibn 6-f the same group of
�idh V4uld lb Iiiii. Iding in a,,dl v
2bucqptinc.-y or in a *di different' ercnt' group of ocoupancy, 'a chZihqt3 of dcob ancy
I,` - I . P
f
'.60 it 'be, p�id to the.: City: UdPe-ct:'_'.6,n foe, o Y,
JF 0 R ICE ITSE
suOPLEM-8NT' AL Ii4�6f�k_ ( V4. V L (,t, c, I - a.
I�A
'Pla
'f t. 6f: b6ildih' 'eck No.
Sq.
I Check
it,No.
qP
Oc6upancy Oro
Occipatt road` Acti& -
No.. of. Stories
Health Ddpt.-ApproVal
Utilitie's :Release d
APPROIIEDBS(,
COM-- Y FETEoc CERTIPICAtE, br,
'ON T.-EE
CHMqcr, or. OCCOPAN& 0`R`q9E 1 M t P 0 c "P. L
11#75-039)
'TOTAL
76