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•l� APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH
DEPA,,TMENT OF DEVELOPMENT SERVICES GATE
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_ ��t-4 ---------- — District _—
Address
3usrness Name__ Occ: Group ---
Business TvCa
BU.,-,rtvFSS OWNER;MANAGER
BU'LDING OWNER a Y K' (
ice.
Name—Ai'� , Home
Address \ � lam'\ +``ti/' -- i Address 4
Home Tei.— -'
City
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THIS USE WOULD'BE DESCRIBED AS: ��----}}
CHANGE OF OWNLR Lt CHANGE OF OGGUp.ANT
EWC? GOt`'STRUC rE D BLDG B
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4 i AF,,'J3TIOtdAL OCCUPANT
J' iuT4ivCa .lILDii+'a %.�AtVC.3r OF USE '.""
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C�+�"�i"--�.__�rJ.-•...,...-Gr4ilre-inCy ar._.,.n...---�""`_`
Indicate fcstnnr us =; if ar 4 ...,. _ w
SQUARE FT OF BUILDtN'1 TO B,. OCCGUf =Gt.r �0 ` �*�C
j #vOI TICS: t - Occupancy Or any building iS, prol +bitc?ll 3 wig flat t7e iSStsed until thek []ikcl'trtCl has
been tr 5p't tE CI Burt d rPrtiricat,... of C^CL,parr,- i .
No electrical service vJii1 be re'sUd #t�s n; k,x,�ttr, building u tit t service has been inspected and
certifaed sate. ll p ,'C3r3t3 forocs Upancy itt uT Xf`aidii I bt IC:int Pre rGGxUirRCi to SG%edttle an e+BGtr4C l
ak ,r+ time this application i5 filed.
,fuse up 4nspeciijrj j-,� the, Departraellt 0a . DeveP C rt
3. Change of pecupancy or use inspec lon fee. 4Nhene ve r Ifs feces nary t.) make inspection of a building
or pr�,mises an order to d0l r,; irle it a rna,!ie may
r be a dj made
tract vision Of the same g cuP of Occupancy
y fx r a$
bL ilding or pfah r � wtllr ht alc3 pl ,re rc txaitdr icy
` c Inspection fee Of--
'fj Or in a dlftest rt gr <up of Occupancy, as Ghan le o, cct3,�a�r. y p-
hB{t8 paid tC the City.
_71y' Huntington Beach Fire Cr?dt~ Section ' : 20 3 requit,Oq that Uw1ding numbers must be a =mini; .urn of four
(4) InoheS 1l,, tiptght with one hae# { },2) inch 5tr�ak,�, .-and of a Contr StiCg cOkq' from the t)ackgrO and. T"Best'
numbers rapist bE} p^sted on `your buitdrnn in a toc� trcri riat js �Isitafe from the street
5. Huntington Beach Fire Code Section 10.301 reg17rt fire t3xtinguisCo:r selection and ttistrtbution eer
the EdatlOnat Fire Prcto ctior j,ssU atior pamphlet IC, (S ,e reverse Side).
(FOR OFFICE USE ONLY) 'ZONkNU
SUPPLEMENTAL INFORMATION
PLAN i,K NU — . - — No. PARKING, SPACES
OCCUPANCY GROUP rL�` �- EPf,tl; C#Ci. _ HEALTH DEFT \PPROVAL
P
OCCUPANT LOAD - _ PERMIT
UTll.t?IES REk.EASED '
NO. t;'STORIES
I:`Ai r F O( r.UI"A{tii Y FF f �a
CEF[TEFt
.—w -- ' DATE CHANGE OF USh t)R Crr- � : UPAN'GFEF
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APPROVED BY TOTAL
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