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( <br />,^-SAJ,{TA <br />AltA,"'i[,]ffi <br />Planning and Building Agency <br />Planning Division <br />20 Givic Center Plaza <br />P.O. Box 1988 (M-20) <br />Santa Ana, Cn.92702 <br />(7141il7-s804 <br />www.santa-ana,org <br />CERTIFICATE OF OCCUPANCY <br />SUPPLEMENTAL <br />QUESTIONNAIRE <br />Please turn in <br />Company Name (Print) <br />this form Occupancy <br />Contact Name: <br />Address (business mailing address): <br />City:State: <br />D Cnange of Property Owner E Cfrange of Occupant ! Change of Use E Additional Occupant <br />1. The following best describes my operation: <br />E office Only ! Retail Sales n Medical/Denta! <br />-fYW"r"nouse/Manufacturing/Distribution ! RestauranUTake Out Food <br />d o,n", (describe) <br />2. <br />4. Has the building or space been vacant or is this a new building? Yes E No M <br />lf vacant, for how long?yn a roth <br />5. Are you an independent contractor? Yes fl No El <br />6. Location of the business and suite number #ao( (.r. Qn#.(7, 'tq.r/q4nr. <br />B lstfloor tr 2ndftoor f] _ftoor <br />7. Do you share the floor or business entrance with another business? Yes E No EI <br />8. What is the amount of square footage leased?7 ood e\E <br />9. How much of the space, which you lease, is office? <br />tr 1oo% tr soYo tr 3oYo <br />lf other than 100%, how is the remaining space used? <br />S : Planning\Clerical-Counter Forms\ <br />CofO Questionnane 08-27 -18 <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 activ.itieqoccur on-pite, the hours of operation, <br />open to the f ublic). who le SaJe d Q.fo, I"U,,,.*AU"io {^W 'frZr'/;'fi:,i op,o to pLl;c <br />What was the former type of businesS or use of facility2 (Please contact the leasing agent or building <br />owner to determine prior business use.) <br />e.-. <br />c4 t3 <br />3. <br />X Less than 30% <br />Phone N"., 76 v eS / qz?Z-mairAddress: