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/,, <br />17. Wll your business be offering the following services <br />I ncohol sales ! Smoking Lounge <br />! AoOy piercing/ Ear piercing ffi <br />18 <br />19 <br />20 <br />21 <br />22 <br />TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND <br />tl <br />?t r/+Date <br />cm\cntr-frm\C of O questionnaire <br />r business be offering massages as part of your business operation? This <br />massage as ancillary to pedicures, manicures, and other services. <br />ruoK <br />ls medical marijuana stored or dispensed at your business? Yes E ruo H <br />Do you prepare or sell food for consumption on or otf the property? Yes E No K <br />lf yes, do you provide sit down service [, drive-through f,, or orders to go/pick-up E? <br />Please explain: <br />Will you <br />includes <br />Yes E <br />Does your business sell automobiles or motorcycles? Yes E No <br />lf yes, please explain: <br />Tattoos/ Permanent make-up <br />None of the above <br />E <br />Does your business service or repair vehicles or install equipment and accessories into <br />vehicles? Yes E *o ,K <br />lf yes, please explain: <br />I DECLARE UNDER PENALTY OF PERJURY, THAT THE FOREGOING STATEMENTS ARE <br />BELIdF. <br />la lu <br />Print <br />Title <br />07t2012 <br />Page 3 of 4 <br />I