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J0, <br /> °caulk' ECIEVEQ ECEIVE® APPLICATION _ BUSINESS LICENSE <br /> JOflCOUNT COMM_ UNITY D_EVE_LOPMENT DEPARTMENT <br /> CO V�P <br /> Community Develop I erlt De I S"t <br /> d�;F.:• ammun P <br /> Business Name: r ' <br /> Business Address: t��' <br /> DBA Mailing Address: �[ CitState: Zi <br /> Phone#: .16 <br /> 11,Assessor Parcel N ber(s): <br /> Email: ) air <br /> Other Businesses at this Address: I ' <br /> Previous Business at Address: i! <br /> } <br /> Type of Business: <br /> i x <br /> At <br />! Type of Organization:{, g ❑ Single Owner El Partnership 11 Corporation El Other: <br /> Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: �- cyy1 Applicant First Name: . <br /> Applicant Mailing Address: ICU '63t I� . <br /> City ��rit C State to,— ZIP X15 `,Applicant Phone No: �'J <br /> i <br /> Water Supply: ❑Pu is On-site Well ,Sewage Disposal: ❑ Public Septic System <br /> Will there be any sale of firearms? ❑ Yes No <br /> NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. { <br /> 1,affirm,all the alcove info rmation-i a and correct ih Date: <br /> Applicant's Signature: <br /> -. 4 <br /> STAFF USf~:O ' <br /> FG—/P Designation: I l_ Zoning: Use Type: <br /> DEPARTMENT APPPPVED DENIED I! DATE <br /> Development Services �, Planner Name: O <br /> Building Inspection <br /> Environmental Health DivVol <br /> Fire Warden j' <br /> Public Works <br /> M.H.C.S.D. ;', <br /> Sheriff(,funk Dealers Only) <br /> i <br /> License Approved For: <br /> Remarks: <br /> liOY <br /> ij Occ.Grp. # <br /> Accepted as Complete: '' Dake: <br /> i FADev5vdPianning Application Forms\Business License(Revised 05-01-08) Page 2 of 7 <br /> i1 <br />