applicationCERTIFICATE OF OCCUPANCY ONLY|office use only
APPLICATION Permit #:_(O -O0 700 =209
Town of Qucensbary Permit Fee:$(00.00
Qi2782BayRoad,Queensbury,NY 12804 tnvoice S129ytdCEEICEOIREDcomersnnTSCEIVEotitdWorkitequitingabuildingpermit****This application is for occupancy ont
CONTACT INFORMATION:TOWN OF QUEENSBURY
BUILDING &CODES.
Applicant:
Name(s):Gilans pele
Mailing Address,C/S/Z:__2od Dix Ave Ques Zar MY 12 doy
Cell Phone:_(5/0_)766-F092 Land Line:_()
Email:_Gux/laws—anv @ akgul-cora
¢Business Owner(s):
Contact Name(s):
Mailing Address,C/S/Z:
Cell Phone:_()Land Line:_()
Email:,
°Manager:
Contact Name(s):
Mailing Address,C/S/Z:
Cell Phone:_()Land Line:_()
Email:
*Property Owner(s):
Business Name:__//-Ful hore ge
Contact Name(s):fen More Lb vee
Mailing Address,C/s/2:_29 DroaG uray 2B.e WS hte,
Cell Phone:_($78_)_29/"dy Land Line:)
Email:_Lepmnmy Sen naakloe Lover 2 hae pe
Contact Person for Building &Code Compliance
Cell Phone:_(S/2_)66-7072 Land Line:_()
Email:-gu ano arnrh@ uhgul.com
Certificate of Occupancy Only Revised December 2017 Oo
303.19-1-71 €0-0700-2019
U-Haul Storage308DixAve
Certificate of Occupancy Only
Town of Qucensbury
742 Bay Road,Queensbury,NY 12804
P:518-761-8206 or 518-761-8205 www.queensbury.net
BUSINESS INFORMATION:
Name of business:“@-fan!shorage
Address (including suite,space,etc.):__20f Dx Ave
Qusen:an A ado
Type of business (i.e.:retail,car repair,etc.):_re Acc
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:La eee fax 4.Lo.Applicant signature:
Date:__s0/4/for
Certificate of Occupancy Only Revised December 2017