Senvice1993 BUSINESS LICENSE APPLICATION FORM
-�P nPw a I, g. CD
r
BUSS.LIC.
IC. NO.
1101111111111111111
77
108-93
i ❑ 1
...... PROOF OF. WORKERS .COMPENSATION INSURANCE IS its . , LT•t�. • � • ,. , �•�
APPROVED BY BUILDING & SAFETY DEPARTMENT
8. If Individual Owner: Social Security #
• 9. Name of Owner C',,92r✓Af4y-) Title: Ot�✓✓'���--
Or Officers
10. Type cf Business: k4 -,1O4 /yiA+✓ / /0;411✓T
11. SBE Resale Number: ,
12. BUSINESS LOCATED WITHIN THE CITY OF LA QUINTA (Does Not Apply To
Building Contractors):
A. Estimated Gross Business Receipts for New Businesses Only:
• Y
i
B. Previous Year Gross Receipts For Established Businesses:
$_ -'. Dy
********GOOD ONLY FOR JANUARY 1,1993 THRU DECEMBER 31,1993*******
I HEREBY CERTIFY tha all the information supplied by me is correct and
any licens s re d by the County, State or Federal Government have been
issu o e d e in full force and effect. Fi—wr-IVEUI A/A'-� / IAV /,: rl' 7 S
,•�
T
% y 'i =• ' � 1 /
BUILDING 8 SAFETY DEPT,
Submit Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION
P.O. Box 1504
La Quinta, CA 92253
e
1.
IS THIS BUSINESS LOCATED AT YOUR HOME:
YES 1/ NO
2.
Business
Name: �/GG ST,,/icr�
3.
Business
Address: OZ/ 4. Mailing
Address:
5.
Business
Phone:
6.
Owned By:
CORPORATION PARTNERSHIP
INDIVIDU�
7.
If Corporation or Partnership: Tax I.D.#
8. If Individual Owner: Social Security #
• 9. Name of Owner C',,92r✓Af4y-) Title: Ot�✓✓'���--
Or Officers
10. Type cf Business: k4 -,1O4 /yiA+✓ / /0;411✓T
11. SBE Resale Number: ,
12. BUSINESS LOCATED WITHIN THE CITY OF LA QUINTA (Does Not Apply To
Building Contractors):
A. Estimated Gross Business Receipts for New Businesses Only:
• Y
i
B. Previous Year Gross Receipts For Established Businesses:
$_ -'. Dy
********GOOD ONLY FOR JANUARY 1,1993 THRU DECEMBER 31,1993*******
I HEREBY CERTIFY tha all the information supplied by me is correct and
any licens s re d by the County, State or Federal Government have been
issu o e d e in full force and effect. Fi—wr-IVEUI A/A'-� / IAV /,: rl' 7 S
,•�
T
% y 'i =• ' � 1 /
BUILDING 8 SAFETY DEPT,
Submit Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION
P.O. Box 1504
La Quinta, CA 92253
e