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I <br />l <br />17. Will your business be offering the following services: <br />f] Alcohol sales <br />fl Smoking Lounge <br />ls medical marijuana stored or dispensed at your business? Yes E No El <br />Do you prepare or sell food for consumption on or off the property? Yes E No E] <br />lf yes, do you provide sit down service E, drive-through E, or orders to go/pick-up E? <br />0 <br />E Tattoos/ Permanent make-up <br />E AoOy piercing/ Ear piercing <br />18 <br />19 <br />Please explain: <br />20 Does your business sell automobiles or motorcycles? Yes E No E <br />lf yes, please explain <br />21.Does your business service or repair vehicles or install equipment and accessories into <br />vehicles? Yes E No E <br />lf yes, please explain: <br />I DECLARE UNDER PENALTY OF PERJURY, THAT THE FOREGOING STATEMENTS ARE <br />TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF. <br />Date <br />nt NameINTER'roR DfrtG\e*/rer.s*tof ur A Doil <br />Title <br />cm\cntrJrm\C of O questionnaire <br />'t112009 <br />Page 3 of 4 <br />AuGoaf ,3. Lol3