HomeMy WebLinkAbout121 Main St - CofO (4)I
I
i
�I
i
1
a
APPLICAI ION FOR CERTIFICATE OF OCCUF-ANCY
CITY OF HUNTINGT(N BEACH
t' DEPARWENT OF DEVELOPMENT SERVICES
HUNTINGTON eEAGH {PRINT OR TYPE ^:)NLYI � DATE
1 AzIcitess __ _.� r,1 .S -I, HC.} J 1 ..L A, (AL. _2.6 419. Di ... ici
BusinessNAmc I� ti• ,� _lZ �?7 7 fY _14s;tz..,;'F} `t : ii�, M Tel.
Business Type '-�SAAIE7�4) I 'St- O? I'�' s'i �{_�� t�Ir (t_ _' Occ. Group
f BUILDING OWNER BUSINESS OWNERIMANAGER
MName_... _ _.___ _._.,,,.....w Name
Home
1
Address __ _ w Address
City Tel. City -Gib 7 I Ai4r i A G s
...�...._...�,.�..,. �._�.w__,�..�..i�. _____._ICI _..�r..H�me Tel.
THIS USE WOULD BE DESCRIBED AS:
NEWILY CONSTRUCT FD BLDG. -} CHANGE OF OWNER IZCHANGE OF OCCUPANT
' EXISTING BUILDING Q CHANGE OF USE f-1 ADDITIONAL OCCUPANT
Indicate Wirnsr usa, if any
SQUARE FT. OF BUILDING TO SE OCCUPIED�_:�
SUPPLEMENTAL INFORMATION
(FOR OFFICE USE ONLY)
ZONING
OCCUPANCY GROUP _
_._
PLAN CHECK NO. ___
NO. PARKING SPACES
OCCUPANT LOAD _ ---
- . -
P4RRAIT NO. - -
HEALTH DEPT. APPROVAL
NO. OF STORIES
._-
ADMIN. ACTION_
UTILITIES RELEASED _
117
r ..
'
CERTIFICATE OF OCCUW.NCY FEE $ ! -
APPROVE?) BY
DATE CHANGE
OF USE OR OCCUPi.NCY FEE $ _.
TOTAL
S �_
76 ^Y'3 RE r'.
r