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I APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH Y^
DEPARTMENT OF DEVELOPMENT SERVICES
r HU TINGTOM REACH
F (PRINT Oil TYPE ONLY)DATE
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Address `. ,' ✓fi d t}
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Business Name
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Tel.
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Business ype_
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d,UILUIhC OVJVFR
OWNER/rAANAGER
Name
Address _Addressf
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City 3!
TeI. W 5
»_ l 'y (r a f' �' c I ; Tel.
THIS USE WOULD BE DESCRIBED AS:
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" NEWLY CONSTRUCTED BLDG. _ CHANGEOF OV, NER
Vim_. i CHANGE OF OCCUPANT
EXISTING BUILDING CHANGE OF USE
� � ADDITIONAL OCCUPANT
Indicate former use, if any . _- _.._.._..Occupaexy Gr.
Div.
(FOR OFFICE USE ONLY)
SUPPLEMENTAL INFORMATION f
SQUARE FT. OF BUILDING PLAN CHECK NO. _ _ � NO, PARKING SPACES
OCCUPANCY GROUP PERMIT NO. HEALTH DEPT. APPROVAL ~^
OCCUPANT LOADS �AADMIN. ACTION ,µ 2-"-
NO. OF STORIES ......,.,.. UTILITIES RELEASED
7
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— -� CERTIFICATE OF OCCUPANCY FEE $
APPROVEDBY
DATE ..CHANGE Of OCCUPANCY FL-1: $..,.
OTAL
76-039REV.
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