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a�P4 .o <br /> PLICATION — BUSINESS LICENSE� 9A= f TY <br /> COMMUNITY DEVELOPMENT DEPARTMENT <br /> JAN 12 2004 /�C <br /> -- BUSINESS LICENSE NO.• -OYGd40? <br /> . �, —:-.••iP S,".v J_Oq_(,itU�N_G�J!1PiTY <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: r orjl �v rpffari. � <br /> Business Address: ` Q _ Cross Sl '//V� <br /> Mailing Address: .Q. -}`Ya �;w ra City: /,PC 2 f a I State: ZIP:$fZ 37 <br /> Phone#: _9 — ZZC7 Assessor Parcel Number(s): e1q-- /�0 —fir- <br /> Other Businesses at this Address: <br /> Previous Business at Address: <br /> Type of Business: (` f^. r' f 7Q. ' LA-'k <br /> Type of Organization: ❑ Single Owner ❑ Partnership ❑ Corporation Other: <br /> Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: C �(C Applicant First Name: (r'4& 1 ,U r /a,/r L(.G- <br /> Applicant Address: 1A 4�;. 5 <br /> City Zp r StajerA I ZIP } Applicant Phone No: <br /> Water Supply: ❑Public '?WOn-site Weil Sewage Disposal: ❑ Public jjor Septic System <br /> Will there be any sale of firearms? ❑ Yes o <br /> NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> Applicant's Signature: Date: 1 Z <br /> ST ONLY <br /> G/P Designaflon: (f Zoning: Co ae/T <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: lrl2ef0 S' <br /> Building Inspection <br /> Environmental at Div <br /> Fire Warden <br /> Public Works <br /> Solid Waste <br /> Enforcement Officer <br /> License Approved For: <br /> Remarks: 14 -^Q/— (4,00 1^0 -.Ml <br /> Accepted as Complete: Date: <br /> F:tDevSvc\Planning Application Forms%Business License(Revised 12-31-02) Page 3 of 8 <br />