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742 Bay Road,c of s su st_v 'Y 1..28 s.
z 518.761• 01 or a w 761- < , k, :
IV EMERGENCY CONTACT I. ---,n ..,
**TITS FORM IS USED tS ISI"`FML E C SERVICEPERSONNEL WHO MAY BE CALLED YOUR
' BUSINESS AFTER HOURS.. LEAS L SURE THE CONTACTS LISTED BELOW ARE WILLING AND y;
AVAILABLE TO REPSOND DURING OFF-HOURS TO ASSIST POLICE AND/OR FIRE PERSONNEL IN
. GAINI i ENTRYTOYOUR
A
PLEASE BE ADVISED THAT FAILURE TO ASSIST EMERGENCY SERVICE IC ' R NN L MAY RESULT IN
10,
DAMAGE TO YOUR BUILDING BY POLICE AND/OR FIRE PERSONNEL
Business Location(including snits,spare. .. .: ; _ µ
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742 a Ly Rued,Queen-shone,NY .22804
P-5.1 -76142 of S1$-761-$7 O Sn ww,q ion.k l,rt#r'e t
$U #NES, 1 FQRIVIAT1 „ie
Name of business: °'� rW
Address (including suite space, etc>).C:de 2:"C'r ,
petalled explanation of business (attar separate piece of paper, if necessary):
3 �_. „
** *Pie provide
to layout
aOl walls, F r a rnou , counters and fixonts
on a separate ens '
J P RA :"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 n outside contractor nd the corresponding documentation
rnr st be provided to rile Town of Queenshury Fire Marshal's office. Fire extinguishing systems
found in kitchens and gas stations require semi-annual r spe ti ns. Any violations noted
duriny an inns .j ,i r retuire it r Teti to lirr i e action and a rejos ecti•rn.
Applicant r __. F _
y � a
£ ax i 1i ant � ire $r .p flat
Properly
�g
rii in, r ": .?+' ,. 3` - Date
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