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HUNTINGTON BEACH
CERTIFICATE OF OCCUPANCY IV-_ 020
CITY OF HUNTINGTON BEACH
DEPT. OF PLANNING & BUILDING APPLICATION
714/536-5241
(3rd Floor —Must Apply ln-Person)
Business License # ,'7_--+b &y 1 Date 5/ 3y/ 11
Business Address 101 ivl _ . d�- �W I A ..4fry.104 Be4Lb_,rA Zip Code C 2tL�
Business OwnersNameSu-m0cnyj IR�(�yJ�„yi Telephone No. ']Irl-S(o1-52-1i
Business NameSorxoCp�•l �jVovlr�wid� �4 mevtcas � LI.E Bus. Phone �l4 - 5�(Q I - 5Zao
Business Type o
Property Owner Information (required) Tenant/Emergency Contact (required)
Name A 6,-Ael "ukr 'L�vrl ( () . LLG Name
Address -15"15 12cwyloIcIS '(7,465 Home Address IA%ii
City }i State/Zip Cat J!Z(A& Cit)qa State/Zip CA i[ 2i g0
Telephone No. -1111- 5-3Lo I.aSLy'�f— Telephone No. '114 - f o I - S
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or ,fi-Existing Building
CHECK ALL THAT APPLY:
O Change of Property Owner ❑Change of Occupant OChange of Use DAdditional Occupant
IN Indicate former type of business n 16U
4 Are you requesting that the clec itybe turned on? YesQ No❑
• Is the buildi» g sprinldered? YesV No❑
■ Will operations produce dust/wood shavings or similar material? Yes❑ Noll
o Will operations involve the repair or replacement of automobile pants YesQ Nojd If yes: Describe the
components repaired or replaced.
Does the operation involve the use of welding or open flame? YesQ No
Will the b ejness be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes QNov
The following best describes my operation: L_ Office Only O Retail Sales ❑ Medical/Dental
O Warehouse /Manufacturing/Distribution Q Restaurant/Take Out Food
(describe process and end product)
Other (describe)
For Official Use Onl
Occ Group: Area: Oce Load:
Occ Group: Area: Occ Load:
Oce Group: Area: Oce Load:
Total Sq Ft Occupied: No. of Stories: TIP Review: Y/ N
Bldg. Permit # Entitlement #: Zoning:
Plnr Initials: Date: Plan Chkr Initials: Date: Insp Initials: Date:
Conditions of Approval or Other Notes:
Inspection Date: