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t. <br /> ,..., • PSANYAQ <br /> APPLICATION - BUSINESS LICENSE <br /> UIN COUNTY COMMUN..ITY DEVELOPMENT DEPARTMENT , <br /> BUSINESS LICENSE NO. f �3v(J <br /> 2005 OCT <br /> 1 ..4� <br /> .. f , <br /> businessName <br /> $ustness Address �q -� 6/ Cross St !`I� <br /> pBA.lUtaihng Addfess:. I41 I =� v _ City 'ThQ: State <br /> Phone#: z <br /> p2 C:.�9 `. 7Assessor Par Ntlmber(s) <br /> other Businesses at this Address. <br /> Previous Business at Addr*: <br /> Type•of Business` <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:CyawkrotApplicant First Name: (l <br /> Applicant Mailing Address <br /> .2(441 <br /> City Mai Un- State A- ZIP 1�5�7 Applicant Phone No: 6q)q <br /> Water Supply: 10Public ❑ On-site Well Sewage Disposal: 91—Public ❑ Septic System <br /> Will there be any sale of firearms? ❑ Yes 99-Wo <br /> NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> I,affirm,all the above for tion is ue and orre t Date: <br /> Applicant's Sig to <br /> STAFF USE ONLY <br /> G/P Designation: Zoning: Use Type: <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: _ J <br /> Building Inspection ^ <br /> Environmental Health Div I�,, ✓� <br /> Fire Warden <br /> Public Works <br /> Solid Waste <br /> Enforcement Officer <br /> M.H.C.S.D. <br /> License Approved For: <br /> Remarks: <br /> C <br /> Occ.Grp. <br /> Accepted as Complete: Date: — $a <br /> F:\DevSvc\Planning Application Forms\Business license(Revised 09-01-05) Page 3 of 8 <br />