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CERTIFICATE OF OCCt1PANCY.
CITY OF FIUNTiVGTON BEACH —
�•' DEPARTMENT OF OEVELbPWNT SERVICES Date
lit1NTINGTOA1 EACH
Address
Business Nantc__:
Tel.
Business Type --- ------
--- Occ. Group.___
BUILDING OWNER OWNER/MANAGE-1
Name
n - --___ --- Name
Address
— _---- Address ___. ----
CitY Tel. . _ _ _ _ ------ s
City Tel. _
Construction ------No. of Sto ies� Occupant load_ __ _ _ ____Sprinklereil
Ndtice: _
This Certificate of Occupal cy DEMOT'' 1ENT OF DEVELOPM-NT SERVICES
SMALL bE posted`In a c6n.0ictiow. place On
the.premises and shall not be removed except
by the"BuiCil'ing 07flcial. by
APPLICATION FOR CERTIFICATE 'OF OCCUPANCYtv t
Department of Development Services
Hunti,
gton Beach
HuMJo�
Z-APPLICANT TO PILL IN (PH'ht 01' type DA
A+ ti6h 'is hereby made for a Certificate tifilrate Of 'Occlops,hcy for a:
IMSCIM9
as
be known ''
s�Amp ( 'ness
"i I
vetted at
usiness Address
0ccqP_an_9x-__Gr_t_ P.iv- 0L
o �y p
SNVessER
ct �z�ame: BUIS OWiness: Residence: No. Bus
4e 0 e 0
--W(Tdres, _&L 41 P one, 0.
BMW NG *�R
THIS` USE VGOLD `DE DESCAWD AS:
ffNewly Cons trected" Bui 1 d i ng
EXist-lYig 'Building
Indicate te Toirmer use if any
E-1 a,aftge of owner
Change of Use
Chane of occupant
Ej Additional I Occupant
Oq,cEah�.r. Gr. Div.
obt be issued
Vs cerise vj "i
panicy 01 an U hg Is pro ands neis W - 1
. _:T. ccu 6;"�is issued.
until the btlfldiK� has been ihspect6d and -a Certificate of OCc
2. -1 No electrical service Will be released for any existing' b6fl' , di6g until the
service has been Ah'spected and certified safe. All a0plicahts for occupAfty
u electrical "fuse up"
bui1diog are required to schedule an elect
'i n� nd CoMm6ni the time
in aw eXist' '-f*B .1 ty Devel'opment at
jinsped.06WIn the Department 6 Odihg a
this applica(iich is filed.
CHANGE OF OCCUPANCY OR I USE INSOt"OWherever'EtN'FEE. WheVer it is necessary to make
inspection of i' premises -in order to. determine if. a tW nge may
a b 0 ifig or �pr mwhich
be made in the"chAra'c"tdr,6f occup6fty,or use of the b'dilding or premises W
of the same qr6op-'of occupancy
'Ing in a different division
would place the bui1d
or in a different group. I of occupancy, a cha6ge:of occu ancy in ect on fee of
$30.00 shall be paidtothe r1ty. 0
(FOR OFFICE USE ONLY)
SUPPLF'MP.NTAL INFORMATION
Sq. ft. of Plan Meck No.
occupancy -Permit No.
Occupant Load Admin. Action
No, Park1nq Spacas — — — - — ----------
No. of Stories— Health, Dept. Approval
Otilitieis Released Z-14
WP_P MOM E _DB Y PANCY FEE $ &.00
r'tRTIF*icATF.'Or- OCCU
(05-030)
MAIME OF OCCUPANCY OR `USE INSPECTION FEL
TWAL
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