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(PRINT ORTYPE 0 DATE
Address District
Bu,iiness-Name Tel.
BtjslnessTypit Oct. Group
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le Name
Address _1_1___u�_?�,___'A
Address
City A—L Tel.'��
city 447_�l
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NMWLYONSTIA - UCTED 8COG. CHANGE OF OWNJER Lq CHAAGE OF'OCCLIPANT
r:xJftING**BU1tblNG CHANGE OF USE [j ADDITIONAL OCCUPANT
Irid t6ate'. f6fiber use, if any
NOTICE: 1 066 MeY f16rfV-bI41ldl1 I i , 9 . - Is'pir I bfflbit6d and -a!bUslness license Will `'ribt be issUed"Oritil tho'bUildiftq
`has been ' inspected id a-c&tfflc?dte,of oc6UoAhicy-Wissudd.
an 2. No electilc-dritil'ifie service has'bieen Inspected
a'l se
. 'Mce Mil-'be-releas6d for any--bMtfiA0 buildiriij:
and' -deft f.af p V60�llca`ntsh 'f or occupahby1n an existing .bijildl' he6"re'qu'iro t'-d�-t''sthe'd6le an
e kfelcal % � ' '- Inspectid-ri"n b b6 : I r se up 6 i p3 ' tff6nt,6f Development SeNices at thollOie this 60'pllch-
t on s'ffletl
pandy�orhw ever I n
is I ecessaryto ryi6ke, Insp,ectl6b,"Of a build-
3. Ohafiod�*bf_' d'
occupancy i d - r vj��d dt fffik r n '
e ne if 6 66 ige may'bo"'We In'. the use
Ing or: prey ses - - wor q f. R64 _f he� WI&M r `"i I s Milo, bblwoldothebulldlh' in a d1ff4e6iWdiv sl6h6 the sMWq
t g-,or,p ern.se w 0
p 0C p oaricy i'nt0e'6fl6n':f6a of 0.00
of -0c 0!- n a ffLiVent'geda"f cu' arjoy a
s a h 11-be paid'tc�rthe pity.
drs!ftst])e a th1h
'601res that biliifdlfig� 6iffib
4. Ifuritih-tbn Beac'h`Fire`Code Seaton 10J ' 66 r
IhOheiOt With*6he alf jY2 Iiri' Rtke, and,6f a
of f6UrJ4 inches' h Y M s
In a-1.6cat'l6fi'that-is visible fr6iwAd'oreet.
ground I , These hUM e
rit6f6f 113da-ch, Flre-C64 . e 'So dt io' 1 11 her selectiin an
5. 10.801 �re6U!res fire extitiobis iddisl-rib fait
per -the NAtl6nal Fire Protection Associ gitibw pats oh let, i 0'(see side
(FObi-�ICF- USE ONL.Y)
R t
S PPLEMEN TAUINFOR AT ON
PLAN CHECK NO. NO. PARKiNr,SPACES SOUARE FT. OF BUILDING
NO. tir-ALTH bIEPT. APPROVAL
OCCUPANCY 6116010 __ PERMi
OCCUPANT LOAD ADMIN. ACTION UT*10TIES RE -LEA
A SED
NO. OF'§TbRIES
6
CERTIFICATE OF OCCOPANCY FEE
AP A 0 V E I)- n Y DATE CHANGE OF OCCUPANCY r-c-E s
TOTAL
'15 03J REV.
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