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DoduSign Envelope lD: 84ED4182-54C3-40C6-8673-9D73C61 FFD5F <br />! Psychologist E Psychiatrist <br />Other <br />16. ls counseling proposed as a part of your business operation? Yes E *o { <br />a. Does your counseling business contract work with a public agency? Yes E <br />lf yes, please describe: <br />17. Wllyour business be offering he following services: <br />10. ls the bultdlng sprtnklered? Yes K <br />"11. Do you plan on making any improvements ta!!C building such as: exterior painting, signage, <br />inteiior tenant improvements? Yes E No EI <br />lf yes, please describe: <br />12. Willyourbusinessincludealobbyorwaitingarea? Yes fl *o il <br />lf yes, what will be the dimensions? <br />13. Do you store equipment, materials, or products within the building? Yes E No V <br />a. Wll there be outdoor storage of equipment, materials, or products? Yes E Uo [EIl <br />lf yes, please describe: <br />b. Witt there be storage ragtrs, pallets and/or shelvlng exceeding 5 feet 9 lnches ln <br />height? Yes E No Vbermttrequtrcdforracks/shelvlngover6', lnqultewtthpermltcountell <br />14. Do you manuf;acture a product at the site? Yes E *o { <br />lf yes, please describe (including process and end prcduct): <br />a. Wilt opentions produce dust/wood shavings orslmilar material? Yes ! ryg. fb. Doesihe operation involve the use ofweldlng oropon flame? Yes E No V <br />15. Does the proposed use involve a patient care professign, such as doctor, dentist, chiroprac'tor, <br />acupuncturist, or physicaltherapist? Yes E No El' <br />a. ls the proposed use within the mential health profession, such as: <br />E NolNotApplicable <br />E Socialworker E <br />D Alcoholsales n Smoking LoungeI eoay piercing/ Ear piercing <br />tto E <br />D JEattoos/ Permanent make-up <br />[flzNone of the above <br />18. Wll your business be offering massages as part of your business operation? T[r includes <br />massage as ancillary to pedicures, manicures, and other services. Yes E No lV <br />19. ls cannabis or cannabis related product stored, gultivated, distributed, tested, manufactured or <br />dispensed at your business? Yes n ruo E}Z <br />20. Do you prepare or sellfood for consumption on or off the property? Yes E f.fo ff <br />lf yes, do you provide sit down service E, drive-through E, or orders to go/pick-up n? <br />S:Planning\Clerical.counter Forms\ <br />CollC OuesuonnairB 0&27-l I