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Please turn in this completed form with your Certificate of Occupancy application. <br />Company Name (Print):6P fi4 d, L Iorulan r, ,Jz<' <br />/t1,ke //2y1,(, J -/v <br />Contact Name <br />Planning Division <br />20 Civic cenlgIl.laq <br />P.O. Box 1988 (M-20)) <br />Santa Ana, CW <br />and <br />,,-SANTA <br />ANA-"H# <br />CERTIFICATE OF OCCUPANCY <br />SUPPLEMENTAL <br />QUESTIONNAIRE <br />www. santa-ana.org <br />Address (business mailing add G869 zuL <br />City:state: Cfr zip'a^ o/? <br />phone No.,7/ 9 -of /E-mailAddress c, <br />{.nung"of Property owner E Change of occupant E change of Use E Additional Occupant <br />1. The following best describes my operation: <br />E ottice only @netaitSates ! ruedica!/Dental <br />I Warehouse/ManufacturinglDistribution ! Restaurant/Take Out Food <br />E other (describe) <br />ottl fias s A lstfloor tr Znd tloor ! _ floor <br />7. Do you share the floor or business entrance with another business? Yes E *o @ <br />8. What is the amount of square footage leased? <br />9. How much of the space, which you lease, is office? <br />tr Looo/o ! 5oo/o tr 3oo/o <br />lf other than 100%, how is the remaining space used? <br />tr Less than 300/o <br />S:Planning\Clerical-Counter Forms\ <br />Cofo Questionnaire 08-27-18 <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 businqss, what activities occur on-site, the hours of operation, <br />open to the [ubtic). 6ct S STQlt an U ,14 C . t?b fc Se /lt .okA ,r/Z <br />No EI <br />fzo/ d. Jtrs/,-fqaft 4rurt 2Z Z "3 <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 />snme <br />4. Has the building or space been vacant or is this a new building? Yes fl No E <br />lf vacant, for how long?6n il,h t lu, //t'r)v <br />5. Are you an independent contractor? Yes E <br />6. Location of the business and suite number: <br />,1