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THE CORPORATION OF THE CITY OF PORT COQUITLAM

“DEVELOPMENT PROCEDURES BYLAN, 1987, NO. 2243"
SCHEDULE -"G"
Enacted by Bylaw No. 2608

APPLICATION FOR LICENCED ESTABLISHMENT
= —

TO BE COMPLETED BY APPLICANT ~- Please print. clearly | FILE NO.

Class of Licence Applied for:

Applicant's Name: Phone:

Address:

| Postal Code
Registered Owner: Phone:

Address:

Postal. Code

Civic Description of Property:

Proposed Use of the Property:

- (Deseribe New Construction Planned }
Dimensions of Property:

Present Zoning of Property:

Proposed Seating Capacity:

Lereryepenrpetund rena woe tht rama

I/We declare that our interest in the property described above is as follows:

.

my

Initials

- Registered Owner or Purchaser under Registered Agreement for Sale

~ Holder of a Registered Option to Purchase

- Holder of

- I am the agent of who holds the’
interest I have indicated above.

(Date)

TO BE COMPLETED BY OFFICE | .
Non~refundable processing fee _ $ 400.00
Fee for newspaper advertising and mailing $ “I, 200.00
(refundable if Public Information Meeting
is: not held). , |

TOTAL FEE PAID ¢ 1,600.00
RECEIPT #
DATE Tee

2608