HomeMy WebLinkAbout101 Main St - CofO (80)Ce rfificatte of Occupancy No. 020M 0 OLf
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APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH - DEPT. OF BUILDING ING & SAFETY
(P Floor - Must Apply In -Person)
Business License # Acn/t a(OrA
Business Address tot mkIN S-r. . I-rF-
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Business Owners Name Mpyy- NEn
Business Name MLR Tg�a�►c�
Business Type
a n ii iNj --�-
Date tM -7 A C-109
Zip Codeg7-6ij%
Telephone No. 6 2,6 -(-76 - 32�j
Bus. Phone 626 -67k- 3Z14
Property Owner Information (required) Tenant/Emergency Contact (required)
Name k%pG rnrrl rr C�esqxName M,� �� t3 �• _�.�
Address 2-73tLiq AA,v-. ->"rrF— 1OS Home Address 41Z
City-rE,,,r-c„L-p, State/Zip cq gZsgQ City ,,.,c.,,z,,,, ( State/Zip CA., r-�q
Telephone No. cty j/ 1Lt1Z - 7q M Telephone No. & 6-7i L_
'-PHIS USE WOULD BE DESCRIBED AS: ��
❑ Newly Constructed Building or Ud' *Existing Building
CHECK A1L1L THAT APPLY:
❑ Change of Property Owner Change of Occupant
Indicate former type of business
❑ Change of Use ❑ Additional Occupant
13 Are you requesting that the electricity be turned on? Yes❑No❑
13 Is the building sprinklered? Yes DNo❑
n Will operations produce dust/wood shavings or similar material? YesDNos�'
13 Will operations involve the repair or replacement of automobile parts Yes ONo [- If yes: Describe the
components repaired or replaced.
13 Does the operation involve the use of welding or open flame? Yes QNo C'
El Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes []No Rr
13 The following best describes my operation: E"Office Only ❑ Retail Sales
❑ Restaurant/Take Out Food ❑ Warehouse /Manufacturing/Distribution
(describe process and end product)
❑ Other (describe)
For Official Use Onl
Occ Group:
Occ Group:
Occ Group:
Total Sq Ft Occupied:
Bldg. Permit #
Area:
Area:
Area:
No. of Stories:
Entitlement #:
❑ Medical/Dental
Occ Load:
Occ Load:
Occ Load:
TIF Review: Y/ N
Zoning: 5;Q6: _�' - —
Plnr Initials:_ Date: "16 Plan Chkr Initials: Date: Insp Initials: Date:
Conditions of Approval or Other Notes:
aFFiC-z W or:j: i
Inspection Date:
(G:Building/Forms/document id goes here)