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KOM 664-1246
664-2246 PLANNING DIVISION 5I'S 7 .
5 199lead each conditionlisted on the reverside side of this form to see
QU1N,Ihe proposed activity can comply with the City's Now occupation
gulations . $35.00 fee
T"r- on 1pIIT 7 N T NK 17
APPLICU40 S NAME ( IPJ L-4 eg h �r /+-L-0 A � li I C � PHONE 5
PROPERTY OWNER " PHONE
PROPERTY ADDRESS 4.7
(street
3
(city) (state) (Zip)
Type of residence, Single/ Multiple, mobile home, etc.)
Type of business 7L-✓-oli rL I1�-
Briep description o
iness will oper
(A,- ee oil
Number of persons involved in business %
List names of persons employed 6-0` 6)t 4!!�- tv CG
Square footage of usable flop�rar a in
house (exclude garage) II ��
Location and square footage of area of
business activity in home (example:
bedrooms; 125 quare feet) B
eaA,a@&- !�Q-r-kZ
Description of machinery, equipment,
business operation as,;/ ne
Y4lid it1 n. St i 35. V
being used in he r1 -on
a Q 7`0- f -? cjz r1t/0
I have read and understand and agree with the conditions by which a
home occupation is allowed (Conditions on reverse sid
'A rig
1 �/
APPLICANT SIGNATURE DXTE
If Applicant is other than property owner, authorisation of owner or agent
required.
11231 /
OWNER OR AGENT SIGNATURF DATE
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.
APPROVEDS Initials - - Date
CONDITIONS ATTRIg
DENILD initials Date
LQHOMOCC.PRT