Loading...
application .___.-CERTIFICATE-OF-O-CCUP-ANCY--ONLY— APPLICATION---------,------, Permit#: E C E E Permit Fee:$ D �� I Invoice#: aa8� 742 Bay Road,Queensbury,NY 12804 Z 2019 I P:518-761-8206 or 518-761-8205 www. uee s u[QfC i TOWN OF QUE:ENSOU Y "This application is for occu ncy-oiilly;with'no-work requiring a building permit" CONTACT INFORMATION: • Applicant: Name(s): Mailing Address, C S/Z: .a d 6 ("I e'► reef 61e",s St- //s, X /990 Cell Phone: S( 1 ) (, a I - AO &D Land Line: J510 `7iQ -SqV/ 7 Email: CPi io IS �ie 0 •. Business Owner(s): Contact Name(s): Lug- �✓ _ Mailing Address, C/S/Z: a 6 ��[��, S G-le�s FQ //,r, P Y Cell Phone- (S ) 1 Q6 ,(;�) Land Line: Email: t�) • Manager: Contact_Name(s): Mailing Address, C/S/Z: Cell,Phone: _( ) Land Line: _( ) Email:. •. PropertyOwner s Business Name: os Contact Name(s): a roL o t S Mailing Address, C/S/Z: 14Sy --e P-od+e I L kz- Cell Phone: (S/ ' )- 3,3 �l 1 - t7 Land Line: Email: I G TI o In S 0- 40/, co Contact Person for Building & Code Compliance: C.Gi✓mac A, ke s- Cell Phone: SI ) -.��! �e7- Land Line: Email: I c4 kqA I c t' CA o(, C,2 �-�- Certificate of Occupancy Only Revised December 2017 742 Bay Road,Queensbury,NY 12804 P:518-761-8206 or 518-761-8205 www.gueensbury.net BUSINESS INFORMATION: Name of business: J nAl kee ors Address (including suite, Space, etc.): ©4r �- C4 � � y ra�ws Type of business (i.e.: retail, car repair, etc.): Please provide an accurate layout of your store showing all walls, exits, stockrooms, rest rooms, counters and fixtures on a separate sheet of paper. IMPORANT:The business owner is responsible for keeping exits clear and maintaining exit signs and emergency lights. Fire extinguishers,fire sprinkler systems; and fire alarm systems require annual inspections by an outside contractor and the corresponding documentation must be provided to the Town of Queensbury Fire Marshal's office. Fire extinguishing systems found, in kitchens and gas stations require semi-annual inspections. Any violations noted during an inspection require immediate corrective action and a re-inspection. Applicant name: f`1e e., t4 do Applicant signature: Dater l I of i; Certificate of Occupancy Only Revised December 2017