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22i
TAP No.13-D019
Application for Temporary Activity Permit
410
CITY OF
HUNTINGTON BEACH
2000 Main Street
Huntington Beach, CA 92648
Planning Department
(714) 536-5271
Shall not exceed 96 consecutive hours (except agricultural sales)
Must display a copy of this permit on premises of activitylocation
A maximum of four events/activities each calendar year are allowed
Violation of any of the requirements listed on this permit is subject to immediate
issuance of a citation
Permitted:outdoor display of goods (banners, pennants, streamers, and flags are
allowed as depicted on the diagram below for activity duration only)
Start DateofActivity:(mm/dd/yyyy)1 EndDateofActivity:(min/dd/yyyy)
DescriptionofActivity:
Locr a Property/Address/Assessor'sParcel Numbe(Ari.t6-0's e z I oo
u essName:
NO0
1
Applicant or Authorized Agent (Please Print)Property Owner (PleasePrint)
10 D .-kek.,
li 'ng Addrkss Mailing Address
1/4*Vr,‘
City t State Zip Cit
1"1
Teiepl;cne Nolaer E-mail Address Telephone Number E-mai! Address
I ha e ad andunderstand the requirementsof this permit r
9 ts -16—(27
Signature of Applicant Date Aignature of Property Owner Date
Please provide a diagram in this space, showing location of activity, directional arrow showing north, streets
andior landmarks, i.e. structures, and layout of site and temporary event fixtures.
FOR OFFICIAL USE ONLY
Fee 20 Receipt # i9 I 39
Bond Rewired: NO 1J4 YES #
Approved: Planning Dept. Initials JZ\ Date 'I 1 •
Planning Mgr. Initials Date
(If Neighborhood Notification is required - SeePP-107)
Fire Dept. Initials Date
Pubi;c Works Dept Initials ps Date 12—iselb3
Police Dent. Initials Date
Distribution: W;-"te Yellow
(Pianniag) (Fire)
Pink Goldenrod
(Applicant) (Code Enforcement)
G:\forms\ping\TempAct_Permit
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State Zip