GOVERNMENT OF THE DISTRICT OF COLUMBIA DEPARTMENT OF CONSUMER AND REGULATORY AFFAIRS BUILDING AND LAND REGULATION ADMINISTRATION PERMIT SERVICE CENTER 941 North Capitol Street, N.E., Suite 2100 CERTIFICATE OF OCCUPANCY CANCELLATION B DENIAL NOTICE ’ CANCELLATION ’ DENIAL Date: __________________ Address of Business: _________________________________________________________________ Owner of Business: _________________________________________________________________ Applicant=s Name & Address: ____________________________________________________________ ____________________________________________________________________________________ Application Number _________________________________________________________________ Proposed Use of Business _____________________________________________________________ REASON FOR CANCELLATION The application listed above is hereby canceled for the reason(s) indicated below: ’ Superceded by application #___________________ date __________________________ ’ Withdrawn by applicant _____________________________________________________ Signature ’ Other (specify) ____________________________________________________________ REASON FOR DENIAL The application listed above is hereby disapproved for the reason(s) indicated below: ’ The premise has been condemned. ’ ’ ’ ’ The premise cannot be cleared by the redevelopment Land Agency. The proposed use has been disapproved by Zoning. (SEE ATTACHED LETTER) The work permits has been canceled or denied. Required permits has not been obtained. ’ Other (Specify) _______________________________________________________ Processed by: _________________________________ Certificate of Occupancy Branch Occupancy Branch Rev. 5/24/99 American LegalNet, Inc. www.USCourtForms.com