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APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH
DEPARTMENT OF DEVELOPMENT SERVICES L. t1UNUNcroN REACH (PRINT OR TYPE ONLY) � BATE
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Address �f �` ,r° � � Y�' �ri,t��;�`» .r_-.....,. District
Business Name Tel,
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Business Type r
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_..._, Ocn. Group.
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SUJLDINd ; OWNER � BUSINESS OWNERIMANAGER
Name �,�sTlrli`r° �'�✓ �. tiA�4rfzeF1'a¢fai'e,.
Address �.:c '.-'� . Home __a c
ram? ,� /� 4 Address" 1!7r
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THIS USE WOULD BE DESCRIBED AS:
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LYCONSTRUCTEDBLDG. CHANGE OF OWNER [� CHANGE Or:OCCUPANT
TING BUILDING F CHANGE OF USE C ADDITIONAL OCCUPANT
Indicate former use, if any _.r: A7zL 7 Occupancy Gr. ___..T Diu.
SQUARE FT. OF BUR DING T O BE OCCUPIED_
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(FOR OFFICE USE ONLY)
SUPPLEMENTAL INFORMATION
ZONING,
OCCUPANCY GROUP __ e
PLAN CHECK NO. _
. _ NO, PARKING SPACES
OCCUPANT LOAD_ _._„ _
PERMIT NO.
—_ HEALTH DEPT. APPROVAL
NO. OF STORIES
_ ADMIN. ACTION ___.�
UTILITIES RELEASED j
CERTIFICATE OF OCCUPANCY FEE
APPROVED BY DATE
CHANGE OF OSE OR OCCUPANCY
FEE $
TOTAL
$ gQ—
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