Pelletier58
HOME OCCUPATION PERMIT
APPLICATION
CITY OF LA QVINTJ
To -!os tell. t•t•de
P.O. Box 1504
Ls ouIntopCA. 92253
�(619) $64 -alas
564-2246 PLANNING DIVISION 5/87
Read each condit on sled on the reverside side of this form to see 17
the proposed activity can comply with the City's Rome Occupation
Regulations. $35.00 fee
TYPE OR PRINT IN INK u
APPLICANT'S NAME R d C �LL E �� EAG PHONE
\ PROPERTY OWNER SI& M 9 PHONE ,
v PROPERTY ADDRESS 5'�-2SS .e_ e e A5 je.a t4 ZF U r X T4_ Z,
(Street(
(City) (State) (Zip)
Type of residence (Single, Multiple, mobile home, etc.)
Type of business CF nj F 9,4 4. (fLD rt/ :RX G +0 /Q
Brief description of how the business will operate O laic
Number of persons involved in business- �-
List names of persons employed % Lcra it/
A Pa I. L. IS 4-) E 2 Ia! F_ to
Square footage of usable floor area in
house (exclude garage) %'l,2,S Validation Stamp
Location and square footage of area of 005i8FAipi462 -ib-89 35.00i0
business activity in home (example:
bedrooms; 125 square feet)
Description of machinery, equipment, and supplies being used in the
-business operation Pio- Q E 2 S L.,& A. i E-A 92 n/ 2 ,y
I have read and understand and agree with the conditions by which a
home occupation is owed (Conditions on reverse side).
,-
APPLICANT SIGNATURE DATE
If Applicant ins o e than property owner, authorization of owner or agent
requ' d.
Z �
OWNER OR AGENT SIGNATURE VATU IF 100,
IMPORTANT: False or misleading information shall be grounds for denying
your Home Occupation, or failure to comply with conditions listed on
reverse shall be grounds for revocation of permit.
APPROVEDNS AeEEDInitials O 0to
DENIEDInitials Date
LQHOMOCC.PRT ,