VILLAGE OF HILLSDALE
HILLSDALE, MO 63121

(314)381-0288

CERTIFICATE OF OCCUPANCY

Permit Number :

Date Issued :

A siie inspection has been performed and passed, therefore permission is here by granted to those named below to occupy the premised located at :

occupant name Relationship Sex DOB
1

Total occupants :

The building commisioner here by certifies that the above occupancy complies with all the provisions of the adopted building codes of the vilage of hilsdale mssouri insofar as can be determined by a site inspection of the premised and a review of the premised, nor is any liability assumed by the village iis officers or employees.

Clerk :