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City of-j4uhtih9ton Beach
FOR APPLICANT TO FILL IN
APPLICATION FOR CERTIFICATE OF OCCEIPA*ttoo[lI ..n
Department of Bui 1 dfhn & Communi
(Print or type only
DATE J—//Z�_
Develdonent
Appl i ca ti on is hereby made for a Certificate of Occupancy for a:
k rpc '&JA11 IfQkiaid*07Gr.)��Div.?,-
tribe Burliness Jse' tvr�
To be known as z
�of Business
V L L.
Located at
Business Address
Qo /ea --
c3t�ii± : i
Phone No.
ame:
THIS USE WOULD BE DESCRIBED AS:
�4ewly Constructer: Building
1
Existing Building
i
Indicate former use i t' any
r�{ Z--
Res dense
Business:
ress
d ress _ K C ty Zip
Residence: - .2'"_c�o
S
Change of Owner
E] Change of Use
,y -[
p --- -- Ph ne o .
j ] Change of Occupant
E-] Additional Occupant
Uccup an y: : Gr.Di v_.
q0T I C."E"--Occ-upancy of any ui i ng i s—pro iM ted an a business license 011 not be sue
a`t until the building has been inspected and a Certificate of Occupancy is issued.
-' l- 2. No electrical service will be released for an existin, buildiA'0- until the
service has been inspected and certified safe. All applicants for oc:ctipaf cy
in an existing building are required to schedule an electrical "fuse up"
v`��--inspection in i
the Department of Bui 1 ding and Community Development at. the time
this application s filed.
3. CN06E OF OCCUPANCY OR USE INSPEC'iIOti FEE. Whenever it is necessary to make
inspection of a building or premises in order to determine if a change may
be made in the character of occupancy or use of the buildiltg`or premises which
would place the building in a different division of the same group of occupancy
or in a different group -of occupancy, a change of occupancy inspection fee of
$30.00 shall be paid to the City.
(FOR OFFICE USE ONLY)
SUPPLEMENTAL INFORMATION
Sq. ft. Of buildi'ngj_00 _ Plan Check No.�
Occupancy Group__ �r ". �_ _ Perini t No.
Occupant Load cAdmin. Action
'4c. of Stories No. Parking Spaces
i
PPRO-CED-BY—�--
Health Dept. Approval
Utilities ReleasedDATE
CERTIFICATE OF OCCUPANCY FEE _$ 4.. eo
CHANGE OF OCCUPANCY OR USE INSPECTION FEE
TOTAL
(.=75-039)