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- bEPARisViPNT-OF`DEVELiSPMENT SI=tiVICES
11UNIrVG ON OtACH WAINT' OFi TYPE 0NLYi DATE
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Business Nar;te
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Wti LN'tONS1thU&YEb 13i-DG. �. I,NANGE "i I `OkFR � CFiA�1GE i)F'OCCUPAPl7
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`i`ING"eb►�YLtSTNC t� ;-GNANGE OF USE
{� Ai�C31�IDtVAt�'OCCtif'ANT
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Occupancy G . Div.
Indlcate'fc5rrher use; if "any _ �. — ----
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bcct pacicy f,any biiiicllrig is" rAffil ed a'nd a busihess license will ri zi tae:issued urltii the bi�itd l g ;
hay beQn inspacteci and a� certifii±ate of occupancy is issued.
` any a jec2. feoai Iservice.Will b6`Wleased fd
and'ca�rtl safe. Aii apiiCants f occtja�icy in_ari eitisti�it�tiilditg`are regtlr to sctiQdie an
electrical ;'fuse un' irispsatiori`in the 0ep 'alit'nubf"Da4eici�ft*itON ces at the'iii�ie'tifiis ap}��ica•
3. Change, of fiCutipe cyi sir ise� nspe.dtl�itt�fee A eliever it isneeespry"io°make`inspetiiian f a kSt fld
9+
iir` ' es iiti°'q!`tlet to�tleterif�i te$if a' haryg mey be made irilbe-ciieraater bf oi''c�i `cy L1se
y in r its
f the titf i i �Kir``tireliiises tiv ieh vito Ib iirce`the' 501.0fig in'n d fferei t t�fi istt rt at the a i r. dp
of &C(IoahcY ar in tl fferei `t gfdo1 bflbecopanry; a'ciielii�e bf"occupan in pecttoii fe'e of $ �. 0
st' it p i ty•
4. „flu%tfi`i".ttbnBQach i+ire'Cate`Sec`tii'{2U8 regres,that'builtliiig nuiirbfsitiiist be a `rirtir(rtlti
�y 9' z: t ontr C
of fatir (�fiies in helhCwlth tt�eXlialf"(h} `inch strokeR.and cif'a c astir alai from°the hack-
rQt� ' These tid i e s mist be listed=fin your t iaili fir n a location that is-vt inie'ft m4tlie s ii;et: ;
9 £: _p
b. b dn'BeeCCade Section 10.301 requires `fire bkti'hgCi shier selectlan and4`c�isiriki tiion
- per rile"Nano`"n i` iru°Pr bktio`I Association �amiii iet'1Q'(see re"verse
eo
t oit OFFICE E ONLY)
5lfPPL MENIAL iNhOfiMAiiC?�%!
_ n10 PARkI G SPACES
: SQUARE FT. OF BUIt 61 /. CSC r� PLAN Cll cl `N0.' — --- ,
ClCcUPAIVCY GROUT' _ ._ _._ _ P -AMIT N0 _ . _ _ __. HEALTN DEPT "AP ItOVA _ _
Occ6PXWT LOAD ___- �� _ __ AUMIN. AGT` ON _ ___ __ ___ __ UT(Cl WS RELEASED
%�r'r
NO:"OF STC�FI1'E _
��,�.S,.A.�-�r_.-��
A0M'6iV--E—O--B-YDATE GHANGE'OF OCCOPANCY FEE
TOTAL
75u39 V. i)L=M.Of'i'r ENT SERVICES
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