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f i MfIFICA*S OF OCCUPANCY
CITY OF HONTMiTON BEACH
gEPtlfIfMENITOF DEVELOMENT SERVICES Date
i(ii+ill\Gl[W REAC11 � -
Dlst'riCt..._—._.____ .
E3uslrtex5 Nante,_._:_
et.
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Group
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Bl)l!;Dlh't3 OWNER OWNEWMANAGEJ_
Name Name
Address
City___gel. Tel. _
Coin#rtrttiori _.______ .Nc. ofupvnt Load__. _______._. _- _ .Srrinkiered
Nnlrce:
This Cartificate at Accupancy DEPARTMEN'C OFbEVELOPMENT VAVICES
,HALL BE Posted in p conspicuous place on
the premises and shall not t3P removed except
by the. Eiuiliin Off Olaf, I,y
APPLICATION FOR CERTIFICATE OF OCCUPANCY
C� of Nuntih�toit'Deach _ --_' _-� _`� oen, rtment 6t Development Services
FOR-APPLICt+NT TO FILL IN (Print itr typ-e only)DATE
Application is hereby made for a'Certificate of Occupancy for a:
ru an c Gr. _fv . Z,
Gt:scri be� � Bus'ihes_s
To be kndwn as
ame Bus Hess
Located at A-/S_�r
13 usfneks Ad"dres
r
.�`
Name: 8U NEVSr tJE Residence Address Ry !ip
Phone No. - Bus"chess :
<, _
r
c'.��?�
ame : BUILDING OWNER Address
THIS uSE WOULD Br D£sCAIBtD AS:
Newljt Constructed BL�iidirlg�� Change of Owner
L Ekis6ng BuiTd4'0g _] CMange of Use
Indi ca+e former use if any _ �s� j • __ _ �_
m m
- p "6hego
Change of Occupant
Additional`Occupaht
Occup,anc, Or. t3iv..
O'Gcuparicy of anyai'd n -s pre ,bto an a ' s� unssfcense issued
until the buildi'rlg'has been inspected and a Certif•Ycate of Occupancy is issued.
No elect;�ical service will be released for any- existing `building until the
service has been -inspected and certified safe. All applicants`for.`occuarcy
in an existing bui~lding are required to schedule an electrical "fuse up..'
inspection in -the Department of Building and Community Development at the time
this application is filed.
CHANGE OF OCCUPANCY VVE INSP!`G'CION FEE. W.hoVer it is necessary to make
inspection of a bui l ding or premises in 'or"der 'to det 'i ilte i f a cha ge may
be made: in the -character of occupancy or use of the bU!-ldiilg 'or premises t.hich
would place the building in a different division of the same group`of occupancy
or in a different group of occupancy, a change cif occup ncy inspectibn`fee of
$30.`00 shall be paid to the City. ,
(FOR OKICE USE ONLY)
SUPPLEMENTAL INFORMATION
Sq . f t . of nu i 1 d i'rirl___ t' _ _
Plan Check No.
Occupancy Grose_____ L _ _.._ permi t No.
Occupant Load Admin. Action
`No. of Stories -_-._..____. "1 — No Parking Spaces __:_�.._� �.
Health utilities ReDept . App►�ovll Spaces______
__ _._. __-_DATE leased
�w Ate! R� Epp.._ DATE CERTIFICATE o I r 'OCtUPAiUC-Y FE $ 6 00
CHANGE OF OCCUPANCY OR USE INS"ECTIO FE --_.
TOTAL^
075-039)