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/j CERfiI iCATE 01='06600A O
CITY OF HUNTItidTON BEActiI �Lj
DEf ARiTMENT OF DEV':LOPMENT SERVIC Gate
` � NW�iTiti'GTr14 8tRr11
f Address
j District._..__
I Business Name___ Tel.
�
Business Type
� Occ. Group.___._____.__.
BUILDING OAFF? mil' OWNERMANAGER
i Name Name
Address Address_
City _ _ Tel. .�. ._._ City Tel.
Construction ____—No. of Stories---- Occupant t_oatl -_._.Sprinklered
Notfce:
�r
y
This Certificatd—f Occupancy DF.PAA'-NT OF DEVELOPMENT SERVICES
SHALL BE posted'in a conspicuous place on
the premises and shall not be removed except
by the Building Official. by
7
APPLICATION OCCUPANCY
,1,6
City_ of 'A htinti Mach Departi-n6lht of �40 idik, & C6MIMMU Devel0n6 t
FOR APPLICANT TO FILL IN (Pl1ht -or ty9e only) DATE I QC_T a "197q
fftan is h"re d q,fpr aCert-if-iqqte of Ocdi
cx
Co be kh-6 as
p57/3
Located at
)ahcy for a,
qr. Di,
s
1-ebij OE ) 4, VM t nPH BUMESs 1;fttOgEl
ress
w 17N "UNTUTO
GREGMY M--Icoftno,
Name: FWMESS OTTER'Residence Address Ci q zi
Phone No. - Business: Residence: y w - 3 TtV
C (2z MeRCL CA
R , Ame%- 4BUIULD*MG( OWNER 1 ty./ Zip
W T-M tj 9 1
/0 : _
s use
ame
"nu V I L.,
BusHess
TRIS'USE WbOLD BE DESUIBED"AS:
C�akewly Constructed Building E--j-' Change of W-her
Existing Build Jig Cunge of (Ise
In'd-ic,ate former use if any
Ej Change of Occu-pa"n t
Addit*16hal '6ccupallt
Od'dIT060: 'Gr. Div.
NOTTUE-T.-
C u of an I)g 1 s TtLd
ancy ------- �TTM a --al—i j�_ I �_h w
until e b0layi4guhas been inE d �nd a CertificateofOccu�
5p�ecte Certifi
2.
No 61eftPical service will: be releas6d for any eXisti6g' build - Mq"Iln_-ILHA the
service has been. i hs ktdd and � certified safe. Al-1 applicants for 6dd'dp6'h%-y
in an ek1stiw61fi1Niq are req0r6d, to sch6dule-ah'61ectr-ical "fuse up"
'in ,of
ft i4spefth -the*Departmeht Building and Coriimtiiilty Devolopmeht at the me
i
this application is filed.
3,
MWE OF OCCOANCY''OR USE INSPECTION FEE. "WK6n6vOr' it is necessary to make
�6f
inspectiona �Wildii g 'or premises in order t6 determifi'e if
* a change may
be made In- the character ofcupAhcy car use the
bu i.hg-6 occupancy !1 d' :or priemises W14cdh
wo'Uld place the Wilding in a different division `of the same &60p of occUp"Ahcy
W7 7
or i n adiffereht group -of occupancy, a change of occupancy:int0ecfj6n1__'fee of
$30.00 shall be paid to the City.
(FOR OFFTCE USE ONLY)
SUPPLEMENTAL
INFORMATION
Sq. ft. of building_
S'79 Pl an Check No.
Occupancy Group
Permit.'No.
Occupart Load
Admi'n. Action
-No. -of Stories
No. Parking arking SpTc_e_i::
Health Dept. Approval
eE Utilities ities �
APPROVE
,R&le�jsed
CERTIFICATE .. IFICATE or ocCOPANcy FEE-$ 6.00
CHANGE OF OCCUPANCY -OR 1JSE INSPECTION FEE
(#75-039)
TOTAL
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