HomeMy WebLinkAbout101 Main St - CofO (32)Certificate of Occuvancv No. 020 011,M o02a1 to
714/536-5271
APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH - DEPT. OF BUILDING & SAFETY
(P Floor - Must Apply In -Person)
Business License # A Z-1 l b ZS Date 7-hg /D
Business Address 10 1 MMv Zip Code 12W
Business Owners Name '1 _6yeg- Ek" Telephone No.
Business Name 611FFW I^Ai2MS t e7t6j _-tNC . Bus. Phoney/j 27y-f�,03`�
Business Type I MIeSWWr 4 DtwELa F*�T- dr %1e Fvel-r 4 iwF" y svwteer
Property Owner Information (required) Tenant/Emergency Contact (required)
Name Name Vev&-t
Address S-71qq 7t siyJ Ayf- ID Home Address 98Z jV 1 j1-
City Mre-tvLA State/Zip VAI q2_S-9 0 City i eW Wykrf State/Zip 64 2_6K
Telephone No. (%!y) 2`1q - dr52 Telephone No. (71 y) .S3 to-ZI 3 q
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or k Existing Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner Change of Occupant ❑ Change of Use ❑ Additional Occupant
■ Indicate former type of business
■ Are you requesting that the electricity be turned on? YesONol�
■ Is the building sprinklered? YesA1No❑
■ Will operations produce dust/wood shavings or similar material? YesONoUR�
■ Will operations involve the repair or replacement of automobile parts Yes ONo U< If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? Yes QNo J J
■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes ONo X
The following best describes my operation: A Office Only ❑ Retail Sales
❑ Restaurant/Take Out Food 0 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: S'�5—'6_ ..._
Plnr Initials: 61-,-t Dater Plan Chkr Initials: Date: Insp Initials: Date:
Conditions of Approval or Other Notes:
6 �r _1Q C-E-67CZ
Inspection Date:
(G:Building/Forms/document id goes here)