HomeMy WebLinkAboutCLE200800180 Legacy Document 2013-02-19Parcel Address: U646 &V LOY- /�>�° City lU (cr State Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? `,zefe�V Mzf /-lCP
Address : /) d( �E�Z�')'9A iZ �? � ity G °V�i�' State i/j_ Zip ZZ 7'vf
Office Phone: L i %-uy Cell # 43`i Cj(vL js`JYax # +" 7 -q'V5 < E -mail
I APPLICANT INFORMATION
Business Name /Type: �I DL'J +9If1L�� SC's neR OJ,
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide: r 1.3Eu.1j
,� =7"e mss. �w...,..W'- ..f! D. „�. ...�sr�.�- 1�"...... ° .. e ... 1-1, 7 ., E1"e ...✓ i N i1 a
*This Clearance will long be valid on the parcel for which it is approved. If you change, intensify or move the use to a new location, a new Zoning
Clearance will be required.
I hereby certify that I own or have the owner's permission to use the space indicated on this application. I also certify that the information provided
is true and accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature s C lA i� / TG/5, Printed td ai . C2yjmm! ,, ��
l / ��etr i cV_
Intake to complete the following:
Y /
Is us n LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will t sere be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on private well or ublic ter
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applie
Is parcel on septic r public se r?
Y/N
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
If so, obtain proper
Y /
Will t ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: 10/7 &I-
0/ N �
Permitted as: A�- a
; "l Ce.✓ `�
Under Section: ;?-y, 2/
Supplementary regulations section:
Parking formula:,./
Z;:�,
Required space,).
Y / V
Items to be verified in the field:
Inspector : Date:
Notes:
Violati ns:
Y/6V
If so, List:
Proffers:
Y/A
If so','-fist:
Variance:
Y/
If so, ist:
SP's:
Y /()
If so, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3