HomeMy WebLinkAbout117 Main St - CofO (2)Certificate of Occuaancv No.-4)2ft m ai6miG l O
APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH - DEPT. OF BUILDING & SAFETY
Business License # j-
Business Address —Ai
Business Owners Name
Business Name
Business Type _�Ltcil
(3'd Floor — Must Apply In -Person)
Date
Zip Code cl VA 5
TelephoneNo.j 1Z4-14V1- $
Bus. Phone
Provertv Owner Information (required) Tenant/Emergency Contact (required)
Name \ l Mai ✓\ 06 L.L .. Name jUt Kj li J D H n6M
Address 0. M 5 Home Address I-P601 5" Lowb-
City j.y vtyll< State/Zip Q - 017-U 9 City N'�i State/ ip C/4- qV* &
Telephone No. �'iQ - ��j2� 2 30D Telephone No. 7 � C/-' ?J%q—
THIS USE WOULD BE DESCRIBED AS:
0 Newly Constructed Building or )< Existing Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner 0 Change of Occupant A Change of Use ❑ Additional Occupant
■ Indicate former type of business
■ Are you requesting that the electricity be turned on? YesONoK
■ Is the building sprinklered? Yes ONo'%
■ Will operations produce dust/wood shavings or similar material? YesON09
■ Will operations involve the repair or replacement of automobile parts Yes QNo If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? Yes QNo A
■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes QNo I�
■ The following best describes my operation: A Office Only 0 Retail Sales ❑ Medical/Dental
0 Restaurant/Take Out Food 0 Warehouse /Manufacturing/Distribution
(describe process and end product)
❑ Other (describe)
For Official Use Only
Occ Group:
Occ Group:
Occ Group:
Total Sq Ft Occupied:
Bldg. Permit #
Area:
Area:
Area:
No. of Stories:
Entitlement #:
Occ Load:
Occ Load:
Occ Load:
TIF Review: Y/ N
Zoning: :5P e5
Plnr Initials: t✓� Date: Z /n Plan Chkr Initials: Date: Insp Initials: Date:
Conditions of Approval or Other Notes:
Inspection Date:
(G:Building/Forms/document id goes here)