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APPLICATION FOR C ;ATIF!CATE OF OC JPANCw
CITY OF IUNTINGTON BEACH FRC--"CEIVED
DEPARTMENT OF DEVELOPMENT SERVICES
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HUNnNGTON BEACH (PRINT OP TYPE ONLY) UN 61986 — DATE
LICENSE DEPT.
Address t D C.� D 21n W '�- <;f . H . Districts p
Business Name—_2/— 1-:�Y1(tf TeL-11
Business Type OccGroup
811ILDING OWNER BUSIIJESS OWNERIMANAGER
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Nama Aame BU� �N(h1�.,Sj • C t- o i
Home
Address Address L E�l\. i�"y�—/t�t %E,A I 4U -
City— Tel. —City tA%�tt —Home Tell 9f%
THIS USE WOULD BE DESCRIBED AS:
NEWLY CONSTRUCTED BLDG. E CHANGE OF OWNER LC - GE OF OCCUPANT
EXISTING BUILDING ❑ CHANGE OF USE ❑ ADDITIONAL OCCUPANT
Ind: ate farmer use, if a,.,, Occupancy Gr.--Div
SQUARE FT. OF BUILDING TO BE OCCUPIED
(FOB; OFFICE USE ONLY) C.
ZONING— '
SUPPLEMENTAL INFOF'MAT!ON
OCCUPANCY GROUP `�
PLAN CHECK NO. NO. PARKING SP.AOES-=
OCCUPANT LOAD
PERMIT NO. HEALTH))EBT: APPROVAL
NO. OF STORIES —
ADMIN.ACTION UTILITIES REL_ASED
CERTIFICATE OF OCCUPANCY FEE," " S S `��
APPROVED BY
CHANGE OF USE OR OCCUPANCY FEE $
TOTAL
75-039 REV.
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Raorder From ART CRA`, BUSINESS FORMS. (714) 535.7957
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APPLICA ION FOR CERTIFICATE OF OCCUPANCY
F
CITY OF HUNTINGTON BEACH -f
DEPARTMENT
HUNr.NGTONBEACH
OF DEVELOPMENT SERVICES -�� � f —
(PRINT OR TYPE ONLY)DATE
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Address %r�o`o.�..vs
District
Business Name 1--05rf -1 S /Z1'e 7-S
_ TeL l /
Business Type dlt! i �i1_ �5
Occ. Group
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_
BUILDING OWNER
Name
OWNER/MANAGER.
Narne l _
Address
Address
City '
Tel. City t o�i/��.f+rJ rI1176� el.
Lt THIS USE WOULD BE DESCRIBED AS:
'NEWL`Y CONSTRUCTED BLDG.
CHANGE OF OWNER �( CHANGE OF OCCUPANT
EXISTING EiUILDING
CHANGE OF USE (� ADDITIONAL OCCUPANT
1 indicate former if
% Occupancy G'. Div,
use, any —G+/
I
I
(FOR OFFICE USE ONLY) S
SUPPI:.EMENTAL INFORMATION k`
SQUARE FT -OF BUILDING E3C PLAN CHECK NO. NO. .PARKING SPACES —
OCCUPANCY GROUP ,G� ^ 2- PERMIT NO. __ HEALTH DEPT. APPROVAL t
OCCUPANT LOAD ADMIN. ACTION - UTILITIES RELEASED EASED �-�
NO. OF STORIES - i'
q OCCUPANCY FEE �
� /
/ CERTIFICATE OCCUPANC� I
APPROVED BY DATE CHANGE OF OCCUPANCY FEE
TOTAL
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75i 039 OEV. ` i �E°1 it...m`"1:..
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