Laserfiche WebLink
Please provide all information requested; an incomplete application may delay approval <br />Zip Code: <br />4 PLAN CHECK GUIDEEHD 16-01 <br />7/5/17 <br />□ Facility Information <br />Name of Facility:~Cjn&\/fO'C\ ^rVoj-h on **= <br />Street Address: ^0^, <br />City:3V0C\4Aon <br />□ Former Name ofTacility <br />________________________________________ <br />, Close: <br />□ OPE^TIOtteLlNgdRMATION \ f fl <br />Anticipated Business Hours:________Open: _ <br />Anticipated Number of Employees: <br />□ Business Owner Information <br />Business Owner Name: CYAexjrorx sAoAions \r\c • - yWy^^nOorTTOm-or <br />Home Address: pQ Oft - <br />Mailing Address: u_____________u_____ <br />Telephone Number: 1Z\ " <br />□ Property Owner Information ————— <br />Property Owner NTm^QC^p^ V\Q,rqU , AWV CUTOm/ foO(V <br />Home Address: fc, CommPrC.I Cn JCG<f r^ , (teXlrflHn . US 8g>U)49- <br />Mailing Address: u <br />Telephone Number: ^0$, - <br />□ Contractor Information ~ <br />NameofGeneral Contractor: SrmAY\ 0.0^^^ UCh'pn ________________________ <br />Mailing Address: ^0^ W\ftdtSOn PiNL . S\jiU '1&0. , CttrUSAUgMS , Cft ■ AqipIO <br />Telephone Number: C||\j > -j <br />Contact Person on Site: <br />Site Phone Number: Q <br />□ Utilities ; <br />Source of Facility Water Supply:__________________ <br />Backflow Protection:___________________ <br />System to be used for Liquid Waste Disposal (Sewage): <br />Solid Waste Disposal to be provided:______________ <br />Grease Interceptor: <br />□ Food Information <br />List food(s) to be served and/or provide menu:_______ <br />5^ otUaUnnxeM' ■