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APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH
DEPARTMENT OF DEVELOPMENT SERVICES "2I - hc y
xuHnvero+a aesc» (PRINT OR TWE ONLY) DATE
Address ,574 District
Business Name ,Js +zsie ` l ' f ti at' ---,..- T Tel. .Z' f 4 _ N
Business Type O
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Cc. Group
BU�LOING OWNER BUSINESS OWNERIMANAGER
Name �s2t2i' �:rGrxa��t 1�i Namerap
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Addressy �G L f' /� t^ tat e ._.._., Address f ��.� �'r�' xsLy, 10/
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City *mow _ !1 C�c Ll C� Te). City % ------Home Tel.. a7- 61, I
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THIS USE WOUL13 BE DESCRIBED AS:
E NEWLY CONSTRUCTED BLDG. CHANGE OF OWNER CHANGE OF OCCUPANT
® EXISTING BUILDING CHANGE OE USE E] ADDITIONAL OCCUPANT
Indicete former use, if any _OCcupancy Gr. Div,
SQUARE FT. OF BUILDING TO BE OCCUPIED- 2.!' o
(FOR OFFICE USE ONLY) } n _az
SUPPLE •iENTALiNFORMATIOtU zrNINCz_� � !
OCCUPANCY GROUP __ "j, PLAN CHECK NO. ,w NO. PARKING SPACES
OCCUPANT LOAD .:'; � . w _ PERMIT 00. HEALTH DEPT. APPROVAL
NO. OF STORIES ADMIN. ACTION UTILITIES RFLEASED 1
CERTIFIOATE OF OCCUPANCY FEE a
APPROVED BY DATE CHANGE. OF USE OR OCCUPANCY FEE $
TOTAL $ '
75.039 REV.