BONANFANT (2)1992 BUSINESS LICENSE APPLICATION FORM
1. Business Name:
Send Completed Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION
P.O. Box 150,4
La Quinta, CA 92253.
� I IIIIII VIII IIII 31
IIII
BUS. LIC. NO
005i82 10 9585 05-01-92 14
10 CASH i TOTAL i i00.00
2. Business Address. l/✓, G- 1%Gl%'u. ��
3. Mailing Address: 42 81 t 2-? �a., Y'3
4. Business Phone: ( ��� ) 56�� FOS
5. Owned By: CORPORATION PARTNERSHIP 3NDIVIDUAL
6. If Corporation or Partnership: Tax I.D.#
7. If Individual Owner: Social Security #
�• Name of Owner or Officers and Title: ,13 c,2`r
-11 w ff\-P r
9. SBE Resale Number:
10. Number of Decals Needed:
11. CONTRACTORS ONLY:
A. Type of Contractor: G e►v� %Zu, l�
B. Classification:
C. State License Number: 622- j ;L 2
CONTRACTORS - GENERAL00 O'0•Per Year
CONTRACTORS - SUB $ 50.0.0 Per Year
or $50.00 Semi-annual
or $25.00 Semi-annual
CONTRACTORS ARE ON A CALENDAR YEAR BASIS ONLY; ANNUAL FROM JANUARY 1ST
THROUGH DECEMBER 31ST. SEMI-ANNUAL FROM JANUARYJST THROUGH JUNE 30TH; OR
JULY 1st THROUGH DECEMBER 31ST.
I HEREBY CERTIFY that all the information supplied by me is correct and
y licenses required by the County, State or Federal Government have been
sued to and are in f911 force and effect.
Sidndtu
Title
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Date
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Date