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APPLICATION --• BUSINESS LICENSE <br /> I <br /> RECEIVElY UIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> I BUSINESS LICENSE NO. <br /> JUL 16 2015 <br /> TO BE COMPLERMIMNEMbOMICANT PRIOR TO FILING THE APPLICATION <br /> PAP 41TURIM-Al 1111112-A <br /> usiness Information <br /> Business Name: <br /> Business Address: D Cross St V <br /> DBA Mailing Address: City: S432cLoin State: ZIP. %S-2-0 S <br /> Phone#: -2-oq- 2 Assessor Parcel Number(s): / 93 ,1/ <br /> Email: ))7 <br /> Other Businesses at this Addr s e <br /> Previous Business at Address: <br /> Description of Business Operation:: 0 rir <br /> rP <br /> pe of Organization: ElSingle Owner ElPartnership )Corporation ElOther.timated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: <br /> plicant Last Name: yvviApplicant First Name: <br /> -Applicant Mai Ung Address: <br /> CityF Y(A(,J State (A ZIP c7537A I Applicant-Phone No: <br /> Water Supply WPublic ❑ On-site Well Sevrage.Disposal: ❑ Public ❑ Septic System <br /> Will there be any sale of firearms? ❑ Yes ANo <br /> NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> 1,affirm,under penalty of perjury that all the above information is true and correct Date: -7 / <br /> I,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 Owne/Agent's project. <br /> Applicant's Signature: <br /> STAFF USE ONLY 1 <br /> G!P Designation: (r Zoning: Use Type: C. r,r< �ci t !+t a/f 0/1 <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: -7 <br /> Building Inspection <br /> Environmental Health DivJAIU4 S400 19 k <br /> Fire Warden <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For <br /> as s' K lah gni <br /> Remarks: IF <br /> Z -—L-3 0 Occ.Grp.. <br /> Accepted as Complete: Date: <br /> F/ApplicaUonsForms&HandoutsrPlanningAppiicabons/Business License(Revised 02-24-15) <br /> Page 2 of 6 <br />