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APPLICATION — BUSINESS LICENSE <br /> �R•�.F•$o ( f <br /> SAf :I�AUUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> .. <br /> 04 SSP 29 PM 4: 45 BUSINESS LICENSE NO._ dL� -_ <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: Lc>V tj L,J e <br /> Business Address: 1pli C V Cross St M <br /> Mailing Address: City: State: ZIP: <br /> Phone#: HC-H Z 1'�; I Assessor Parcel Numbegs): <br /> Other Businesses at this Address: <br /> Previous Business at Address: <br /> Type of Business: Z <br /> 6' <br /> Type of Organization: ingle ner ❑ Partnership ❑ Corporation ❑ Other: <br /> Estimated Number of Full Time Em loyees: Estimated Number of Part Time or Seasonal Employees: �G <br /> Applicant Last Name: Applicant First Name: <br /> Applicant Address: p t\YM Q L <br /> City - -C N State C_P�- I ZIP7-CYL11 Applicant Phone No: <br /> Water Supply: Oflablic ❑ On-site Well Sewage Disposal: cepic ystem <br /> Will there be any sale of firearms? ❑ Yes 111-14-0- <br /> NOTE: <br /> 11-IQoNOTE: ANY CHANGE OF OCCU ANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> I,affirm,all the above inform ition is true and correct Date: <br /> Applicant's Signature: �po <br /> (:;�aSTAFF USE ONLY <br /> G/P Designation: '— Zoning: Use Type: <br /> DEPARTMENT APPROVED DENIED 11 DAT <br /> Development Services Planner Name: <br /> Building Inspection <br /> Environmental Health Div <br /> Fire Warden <br /> Public Works <br /> Solid Waste <br /> Enforcement Officer <br /> License Approved For: e v � <br /> Remarks: - <br /> - - Occ.Grp. <br /> Accepted as Complete: Date: <br /> 1 F:\DevSvc\Planning Application Forms\Bysiness License(Revised 07-28-04) Page 3 of 8 <br /> f <br />