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This is,Ao certify chat` thr= __. _�m i e � 3t i.lt�i -- 't r �Wt1 � —__ as a0th* ii c i
under B011(fiirig'Nrrt'st fda, I ,►_<_ and is ideh ifitti as '`��3 �. �8 t
audios.
rit . A
h *aricl ciescfiitaeci as
in the'6 ildihq owne' f y �?�� Yx• ►�1�"Q1 ti!'�� �L.LS.�g� at
'namct ntidrer4
cOt i)lies wi ts' ttie {irovisioiis of afi! pertinent` laws, �oties; o'rryii an y art) pused
Corm 1116hs � far `the use cfescr`it�e d anti clas$ ifieii as an *�2__(Sh'l t )ii�iari y.
MA <WijM`OCCLlPKN' " 'L0AD'PEf MiTTED
A,c We:
T' ifs gbotificate cif, , dcc f» {�y ' Jatj "` F. Bef r its
HA! L ESE pcisteii il� a ,c�anstiit;tto +s filace `i ri r�rreetor or auiiding & community'bevelopment
ft;e?�5renlises aid shill nit `be'ictrtr���att excit�t
try the E30tttilttg Off it ►al. gy-Z&_1
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art^ �y 1 r �f, t [ r�t� �{`�.}m., n��t r"
`lf��F-.�l.l\ f►�l;.A.�tY C Vit. l't'�R14*T,!'SJ. `hT1, bl? '.lC [1t'l' i
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�Cit;y °o f` 14iii} t n i tat, Beach � tics `irt i° t"mist!# �f; 110i 3.`fl l flc £� coinitiuni # bcf��lo sfic0t t.
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FC3R Fi'L1GA T 'r() TILL �N_ (PrJ:i)tT 6r.� type orf)y)
t.i;on is hereade, for. a Certificate 'of 0c,d4opancy .for "A!
IA-1
De'scribe Business 'UseTO'' be known
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N�MO of B6s tic s -
iftess cicircrs{�
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Na7'e: BUILDING 01 ER Address city ri.i� T'�ione, NO.
TBTS U1 WOULD B � DESCRIBED AS y
itewl Constructed `t3fd.l:di h �' Chan e of owner Chan(o 61. Occtipant
g L. � c3 a � - �
1 Exist. ri`t Pui:tclincl Chailrycy cif' Use Additional E7c C',U pant.
Indicate form
use A.f any:
C�'t:G%7 �2t ,�'' cr-a �.lt'.� c::�'.�L.'' • ,e.
NAii (,,,: B -SS '0WNER `Re 61 Piddr s.� City � d
# Phone No. -- Bu�iriess Residence
SMOA
NOTF. 06dupaiioy of ahy bbilding i.s prohibited Aid a bt#sanz�:;r, l'�cense will no 'be
", ° 'issued: ufitit the bfUldif has `been inspected and a cn)-tificcat:e of occu anc;�
5 1 t �'
�.,.` CUI is s issued.
..� No elect rical service will' be xele#sea for aria existing, building' tifit i.l, the
'�� j.---fir t�ry ce has been itis ecf ec3 at d certified safe :All applicahts for oc:c upailscy F
.-y in aid e:tisti ig bt��:ld ncJ are reriui.red to schedule an electrical, "fuse
C . section iiithe Department of-Buil.di.ng aril CommUh1ty 'Development at. Lhe
time` this a' 11,catidn is filed.
3. CHAMGE r'`<�CCU'MNC �t6R USE TNSPEC:TtoN r'EE. Vhenever it- is"necessary to make
x.nspecti a'rr of a but l di.hg or ``riremi.ses ? tY circler to det'e mine i f a "charge; may
be made "in the 611hracter of occupancy or Ose of "the 'buii'di:ng or I remis6s
r4fl� aY�icth would place `Ehe'Uuz.ldingin `a clif`oret: di.visi:or� of the: same <rotP of
�f occupancy or in a different groin of occupancy, a change .of occupancy
fnsp cticin- foe of $25°.00 shall he paid to: the city
8UPPLE'MENTAL i Nr'C7RMA tON
sq:, ft. 6f`'bOil.dib rn (� -in Check�Ic�. A P—t-
CCctpancy Gro�if>rmi.t: 't10 .;IL
ccupan t Load / JI Admin.: Action ,--
1 .0 of:-StbratesYTZ) PIv. Isarking S 'aces -
`-` Health ire t . Approval
:. `ER C TI FICA'i'L OF OCCUPM4CY-
j GH NGE OFt7GCL1t1CY _OR U E ° 1 N8P�G'Tl"C7N' I E'E =r► �: