Laserfiche WebLink
a <br />a <br />17. Will your business be offering the following services: <br />E Alcohol sales E Smoking Lounge <br />E goOy piercing/ Ear piercing <br />E Tattoos/ Permanent make-up <br />-El-None of the above <br />property? Yes E NoEl <br />f], or orders to go/pick-up E? <br />18 <br />19 <br />20 <br />21 <br />22 <br />Will your business be offering massages as part of your business operation? This <br />includes massaqg as ancillary to pedicures, manicures, and other services. <br />Yes E r.ro T1- <br />ls medical marijuana stored or dispensed at your business? Yes E f.fo 6- <br />Do you prepare or sell food for consumpti <br />lf yes, do you provide sit down service E <br />Please explain: <br />Does your business servi <br />vehicles? Yes E No <br />lf yes, please explain: <br />on on or off the <br />, drive{hrough <br />Does your business sell automobiles or motorcycles? Yes ! No <br />lf yes, please explain: <br />d-- <br />cg or repair vehicles or install equipment and accessories intoF <br />I DECLARE UNDER PENALry OF PERJURY, THAT THE FOREGOING STATEMENTS ARE <br />TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF. <br />(- (t -r4 <br />Date <br />Print Har <br />c\.r-\ <br />Title <br />cm\cntr-ftm\C of O qu€stionnair€ <br />07t20't2 <br />Page 3 of 4