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Please turn in this completed form with your Certificate of Occupancy application. <br />Company Name (Print)UL ffi67a,zz/c . <br />Contact Name: h" <br />,,-SAI,[TA <br />ANA-"'i,[]ffi <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 />(7141il7-5804 <br />www.santa-ana.org <br />CERTIFICATE OF OCCUPANCY <br />SUPPLEMENTAL <br />QUESTIONNAIRE <br />Address (business mailing address):ttz- e . ts 5r ta;rfl sn <br />c,tv,OhtA W* state: U zip lzh( <br />Phone No *V- L9" -2<va E-maitAddress: A*q-,frRa P ryl6r'A+. ArTD6 <br />E Cnange of Property Ownerrfr Change of Occupant ! Change of Use E Rdditional Occupant <br />1. The following best describes my operation: <br />,toor..only ! Retail Sales n ueaicat/Dental <br />E Warehouse/Manufacturing/Distribution fl Restaurant/Take Out Food <br />E Other (describe) <br />2. 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 public). Dle t41z"4*z- h*-**f _ M _p - g _ { .*tfant-e DAYEZ{/ruflT Socur-a . <br />3. What was the former type of business or use of facility? (Please contact the leasing agent or building <br />owner to determine prior business use.)9tn/ue . <br />4. Has the building or space been vacant or is this a new building? y", d No"E <br />lf vacant, for how long?b - ovh\. <br />5. Are you an independent contractor? Yes n Noud <br />9?-o6. Location of the business and suite number: <br />tr l stfloor tr 2nd floor ,ff,16rtoo, <br />7. Do you share the floor or business entrance with another business? yesd No E <br />8. What is the amount of square footage leased?*soo. 9a Pi <br />9. How much of the space, which you lease, is office? <br />tr looo/o ilv"r" tr 3oo/o <br />lf other than 100%, how is the remaining space used? <br />n Less than 30% <br />fuValA- dfut+ttt- tht'l'nt q5-E <br />S : Planning\Clerical-Counter Forms\ <br />CofO Questionnare 08-27 -1 8