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Please turn in this com form with your Certificate of Occu,'pplication. <br />Company Name (Print)E) <br />Contact Name : <br />Address (business mailing address)+tg <br />City:5"^l^ [Aft slad: (-'4 zip qzlol <br />Phone No.:( -7t4\ SsO - q{., R l,' E-mail Address c <br />E Change of Property Owner E Change of Occupant E ChangeofUse D Additional Occupant <br />1. The following best describes my operation: <br />E otfice only E Retail Sales E Medical/Dental <br />n Warehouse/Manufacturing/Distribution ffilflestauranUTake Out Food <br />n Other (describe) <br />Please provide a brief description of how the business operates at this site (for example, please <br />describe the general nature of the business, what activities occur on-site, the hours of operation, <br />open to the pu blic). f.l,- t > 9ct"t- V4tn Maxrczirr.Ees\ 6.,6 . <br />3. What was the former type of business or use of facility? (Please contact the leasing agent or building <br />owner to detemine prior busirless use'.) 1;a"\ f,e.J (,lf.rrreirt'-tr r.,J <br />4. Has the building or space been vacant or is this a new building? Yes E No EL <br />lf vacant, for how long? <br />5. Are you an independent contractor? Yes ! ruo E. <br />6. Location of the business and suite number: <br />EL 1ufloor fl 2nofloor tr floor <br />7. Do you share the floor or business entrance with another business? Yes E No EL <br />8. What is the amount of square footage leased?lso ' <br />. C<: kl <br />2 <br />9. How much of the space, which you lease, is office? <br />B 1oo% n sov" E goz <br />lf other than 100%, how is the remaining space used? <br />S:Planning\Clencal-Counter Forms\ <br />Cofo Ouestionnaire 08-27-18 <br />! Less than 30% <br />*-SANTA <br />NAqHffi <br />Planning and Building Agency <br />Planning Division <br />20 Civic Center Plaza <br />P.O. Box 1988 (M-20) <br />Santa Ana, C492702 <br />(714) 647-5804 <br />www.santa-ana.org <br />GERTTFTCATE OF OCCUPANCY <br />SUPPLEMENTAL <br />QUEST!ONNAIRE <br />o