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Business Address 10
Business Owners Name
Business Name.
Business Type _
CERTIFICATE OF OCCUPANCY 020A'�- o l
CITY OF HUNTINGTON BEACH
DEPT. OF PLANNING & BUILDING APPLICATION
Ord Floor - Must Apply In -Person)
Date 3-/`/ -//
Do Zip Code
Saycle Telephone No. 7�10 O0Gy�✓
l c Te' yw%le Bus. Phone 7/S'371/ 3V8'
� r To64-uJ e-c,-e
Property Owner Information (required) Tenant/Emergency Contact (required)
Name , � �h«,/; ve amejW Name i
Address i t r" Home Address q �&7
City State/Zip _ ��/7 City l�tL"i�ei•� State/Zip �
Telephone No. r%11 5,2w 6 S11-1 % Telephone No. 71 `f OCI%6 5765
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or Existing Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner 'N� Change of Occupant ❑ Change of Use ❑ Additional Occupant
■ Indicate former type of business
■ Are you requesting that the electricity be turned on? Yes[]No❑
■ Is the building sprinklered? YeANo❑
■ Will operations produce dust/wood shavings or similar material? YesE.]No-5
■ Will operations involve the repair or replacement of automobile parts Yes ONdC If yes: Describe the
components repaired or replaced. __
■ Does the operation involve the use of welding or open flame? Yes DNo
■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes ONo`Q'
The following best describes my operation: Office Only Retail Sales
❑ Restaurant/Take Out Food 0 Warehou nng/Distribution
(describe process and end product)
❑ Other (describe)
For Official Use Onl
❑ Medical/Dental
Occ Group: Area: Occ Load:
Occ Group: Area: Occ Load:
Occ Group: Area: Occ Load:
Total Sq Ft Occupied: No. of Stories: TIF Review: Y/
Bldg. Permit # Entitlement #: Zoning: Spy- C.-7 .
Plnr Initials: Date: Plan Chkr Initials: Date: Insp Initials: Date:
Conditions of Approval or Other Notes:
1)1.v� J r l4r n N tM _
cr ( X >- = LDFI%t cc- orb
MD GnE o 9-cG?'9.
Inspection Date:
C
GG L4f
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