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I <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 />(7141647-5804 <br />www.santa-ana.org <br />CERTIFICATE OF OCCUPANCY <br />SUPPLEMENTAL <br />QUESTIONNAIRE <br />Please turn in this completed form with Ceftificate of Occupancy application. <br />Company Name <br />Contact Name: <br />City: <br />(Print):/u,'4n46 L <br />fz^rn .4ra state: /?4 zip, ?376i <br />Phone No ?':t,t J,{* t '' E-maitAddress: -fDgeaar*b,pz4uff:a,&,4- <br />E Cnange of Property Owner ( Cnung" of Occupant ! Change of Use E Additional Occupant <br />1. The following best describes my operation: <br />p-Ofrice Only E Retail Sales n Medical/Dental <br />E Warehouse/Manufacturing/Distribution E Restaurant/Take Out Food <br />fl Otfrer (describe) <br />lf vacant, for how long? <br />5. Are you an independent contractor? Yes E *o F <br />6. Location of the business and suite number: -/7t74 <br />l15tA <br />E. DY€IL ?,V <br />F tottoor. tr 2ndfloor ! <br />-ftoor7. Do you share the floor or business entrance with another business? Yes E ruo B <br />8. What is the amount of square footage leased? <br />/ <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 actjyjties occur on-site, the hours of operation, <br />open to the public). AirZfflaZ*T ftlfat I rcrrf <br />3. What was the former type of business or use of facilityT (Please contact the leasing agent or building <br />owner to determine prior business use.) ,/o/^ <br />4. Has the building or space been vacant or is this a new building? Yes E *oF <br />9. How much of the space, which you lease, is office? <br />* toow tr soYo tr 30% <br />lf other than 100%, how is the remaining space used? <br />S : Planning\Clerical-Counter Forms\ <br />CofO Questionnaire 08-27-'1 8 <br />% <br />n Less than 30% <br />,,-SANTA <br />ANA-'iiNJffi <br />Address (business mailing address):