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EJV f1 APPLICATION - BUSINESS LICENSE a h OAQUIN COUNTY COMMUNITY DEVELOPMENTT DEPARTMENT SEP 15 2016 BUSINESS LICENSE NO. ENVIRONMENT FERMIMFgoCPS TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION Business Information Business Name: 1 6 &10, f r Business Address: 3 N W LSUI-A -Cross St 13 v. DBA Mailing Address: 'I,d a ;n N p 'fJO Cly_ v WJ State: ZIP: T,J'2a Phone#: I I ()I '1, Assessor Paroel Number(s): I f 1 '1gI�2 Email: !.b(;r( ('J PS v.. Other Businesses at this Address: Previous Business at Address: //�� Description of Business Operation:: tic work fd Q OL boof 5 Type of Organization: A Single Owner ❑ Partnership ❑ Corporation ❑ Other. Estimated Number of Full Time Employees: L Estimated Number of Part Time or Seasonal Employees: Z Applicant Last Name: (d Applicant First Name: EA -Applicant Mailing Address: 341-0 \d t O V V 2 City r �. OrJ State 6A ZIP '13-Z J4 Applicant-Phone No: Water Supply: Ripublic ❑ On-site Well Sewage Disposal: .ff Public ❑ Septic System Will there be any sale of firearms? ❑ Yes In No NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. I, affirm,under penalty of perjury that all the above information is true and correct Date: I,the Owner/Agent agree,to defend,indemnify, and hold harmless the County and its 0 o I I 1 agents,officers and employees from any claim,action or proceeding against the County arising from the Owner/Agent's projec Applicants Signature: 2 ✓ STAFF USE ONLY GIP Designabon: Zoning: r Use Type: 150,(j I(tz A, a 51 DEPARTMENT APPROIJED DENIED DATE Development Services V Plan Name: Building Inspection Environmental Health Div 5N� Su# Ila -16ab Fre Warden Public Works -- - M.H.C.S.D. License Approved For. Remarks: Dcr-Grp. Accepted as Complete: Date F/ApplicationsFonns&Handouts/PlamingAppllrations/Business License(Revised 02-2415)