HomeMy WebLinkAboutTemporary Activity 20140009 - PageTAP No. I V14--oo
Applicationfor TemporaryActivity Permit
0
2 d
'
I have read and understand the requir ments of this permit
S gnature of p I. t Da e Signa ur of P Dateperty Owner
PA RR m/es 5-pfret
DE ora /NS caotA
Please provide a diagram in this space, showing location of activity, directional arrow showing north, streets
and/or landmarks, i.e. structures, and layoutof site and temporary event fix ures.731-
T-etAL
\Lpir-00 SCe -es(N\.A_MAITPE,SeC &ale
/A-ttE A
iv\ et-1-1reiE
SerD ti,—
1-6-1T =IDIxd30
V.zpo (kr
9or
-2_
State Zip
E-mail Address
NI
Telephone Number
90
City
Pink Goldenrod
(Applicant) (Code Enforcement)
G:\forms\pIng\TempAct_Permit
Shall not exceed 96 consecutive hours (except agricultural sales)
Must display a copy of this permit on premises of activity location
A maximum of four events/activities each calendar year are allowed
Violation of anyof 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 Date of Activity:(mm/dd/yyyy)0 End Date of Activity:(mm/dd/yyyy)
Description of Activity:-1-
Location of Proyerty/Address/A sessor' Parcel Number (APN):
Business Name:5 M
Applicant or Authorized Agent (Please Print)Property Owner (Please Print)
- e— I\1G-u(Ex)
Mailing Address Mailing Address
I ""b
City State Zip
Telephone Number E-mail Address
-C140(
1.1c6TE
I 160 d'N CcK- y %tik
'Rrazilb; %vu.tXTv-ko.)IsilFt_ 24 to Ira.
3.
oyz-kl-t
4zzo
FOR QFFICIAL USE ONLY
Fee.2-e>1 Receipt #
Bond Required: NO YES #
Distribution: , White Yellow
(Planning) (Fire)
CITY OF
HUNTINGTON BEACH
2000 Main Street
Huntington Beach, CA 92648
Planning Department
(714) 536-5271
LEE
IqL4-3(0
Approved: Planning Dept. Initials Date •q ••
Planning Mgr. Initials Date
5.114..(If Neighborhood Notification is required —SeePP-107)
Fire Dept. Initials
— Public Works Dept.Initials
Police Dept. Initials
s-