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HUNTINGTON BEACH
Business License #
Business Address
CERTIFICATE OF OCCUPANCY
0200-0-
CITY OF HUNTINGTON BEACH —
DEPT. OF BUILDING & SAFETY APPLICATION
714/536-5241 (3rd Floor — Must Apply In -Person)
Business Owners Name
Business Name l�i-XGfzGf %Yt e
Business Type C40P- 1AA+"e ar Pail,
Date If
Zip Code I
Telephone No. 7(g 96 6 S�Zo o
Bus. Phone kaao c/K .
Property Owner Information (required) Tenant/Emer enc Contact (required)
Name rM X t H 1 ( /z �i�i Cd ��1� i— Name L
Address K'y oV?f C(4--6) Home Address .r 6(
City State/Zip Q/ 2�4 7 City f - State/Zip f q26 4G
Telephone No. // < 3 ! 6 Telephone No. 2jL4 94 2 ( 4 6 2
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or §fltxisting Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner ErChange of Occupant ❑
■ Indicate former type of business
of Use ❑Additional Occupant
■ Are you requesting that the electricity be turned on? Yes o ❑
■ Is the building sprinklered? Yes- No
■ Will operations produce dust/wood shavings or similar material? Yes Nok—'
■ Will operations involve the repair or replacement of automobile parts Yes Noo--"If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? Yes Q NQ�i—
■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes I]NoNl---
■ The following best describes my operation: QOffice Only ❑ Retail Sales ❑ Medical/Dental
❑ Warehouse /Manufacturing/Distribution ❑ Restaurant/Take Out Food
(describe process and end product)
❑ Other (describe)
For Official Use OnlyUse 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: oth
TIF Review: Y
Zoning: $P5— r✓?,-
Plnr Initials:_ Date: 1 wT Plan Chkr Initials: Date: Insp Initials: Date:
Conditions of Approval or Other Notes:
Inspection Date: