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"7--50 -1 5- <br /> `''" APPLICATION -- BUSINESS LICENSE <br /> •.oRECE <br /> AQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> JUL 16 2015 BUSINESS LICENSE NO. �L_ <br /> dr'ts:aii <br /> ENORONME <br /> NT <br /> TO BE COMPLE PPLICANt PRIOR TO FiLING THE APPLICATION <br /> usiness information' <br /> Business Name: IVC 0 f <br /> Business Address: '-1 y �tI SS' tF Cross St <br /> DBA Mailing Address: City. } State: ZIP: <br /> Phone#: �\ (3 e (9� �r Assessor Parcel Number(s): 2- `� D 3 d b'3 <br /> Email: R Lq) H A L\`~v L..�. <br /> Other Businesses at this Address: -- <br /> Previous Business at Address: <br /> Description of Business Operation:: ,lA 7 i o v r b- � /k/A _ <br /> Type of Organization: ❑ Single Owner ❑ Partnership Corporation ❑ Other. <br /> Estimated Number of Full Time Employees: CEstimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: IM A L Applicant First Name: I- ,p <br /> -Applicant Mailing Address: (itJ a (—f T 1-04T D <br /> City Stat zlP Applicant-Phone No: CJ - F' �46 <br /> Water Supply: ❑public On-site Well Sewage Disposal: ❑ Public 04 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,under penalty of perjury that ail the above information is true and correct Date: <br /> 1,the Owner/Agent agree,to defend,indemnify,and hold harmless the County and its <br /> agents,officers and employees from any claim,action or proceeding against the County <br /> arising from the OwnerlAgent's project. <br /> Applicant's Signature: <br /> STAFF USE ONLY <br /> G/P Designation: l/ Zoning: C --'� Use Type: "1�(fJ(Li'tQ C �Mlolrta-�1GYJ <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: / I '. gx( , t.(r <br /> Building Inspection ,/ <br /> Environmental Health Div Li'O(3/a.5 lP / IJ <br /> Fire Warden v'(14- ' <br /> Pubilc Works <br /> M.H.C.S.D. <br /> License Approved For. C� <br /> Remarks: 31--'12-0212, 61-W,271 <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F/ApplicationsForms&Handouts/PianningAppiica6onVBusiness license(Revised 02-2415) <br /> Page 2 of 6 <br />