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Please turn in this completed form with your Certificate of Occupancy application. <br />Company Name (Print) <br />Contact Name:36; <br />Address (business mailing address):)oll E hr"r. sr \U-7 <br />City:S nnra Anrx state: fA zip: ?>-lot <br />phone ruo., 5)b - )l> - 9r!] E-maitAddress: Menarrra,q9ltl @ 4na; (,cuvt <br />UdChange of Property Owner E Cnange of Occupant ! Cnange of Use E Rooitional Occupant <br />1. The following best describes my operation: <br />E Orice only E Retai! Sales E Medical/Dental <br />E Warehouse/Manufacturing/Distribution E RestauranUTake Out Food <br />U otrrer (describe) l*y" I M,,,^c5 *?v\V <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). <br />ftwsry I hn^ct gerv\se lo,a Al^ - 7t]. Pnn Daity <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.) <br />9rt.- <br />4. Has the building or space been vacant or is this a new building? Yes E ruo El' <br />5. Are you an independent contractor? Yes E tlo UI' <br />6. Location of the business and suite number: )a[1 b D^*C gf fla-l <br />g 1st floor tr 2nd floor E <br />-floor <br />V <br />7. Do you share the floor or business entrance with another business? Yes E Xo p| <br />8. What is the amount of square footage leased? <br />9. How much of the space, which you lease, is office? <br />tr 1oo% tr soo/o n 3oo/o <br />lf other than 100%, how is the remaining space used? <br />g Less than 30% <br />S:Planning\Clerical-Counter Forms\ <br />CofO Questionnaire 08-27-18 <br />J)- <br />*-SANTA <br />ANAJlilil[ <br />Planning and Building Agency <br />Planning Division <br />20 Civic Center Plaza <br />P.O. Box 1988 (M-20) <br />Santa Ana, CA92702 <br />(714) 647-s804 <br />www.santa-ana.org <br />CERTIFICATE OF OCCUPANCY <br />SUPPLEMENTAL <br />QUESTIONNAIRE <br />lf vacant, for how long?