SCHEDULE "B" — enacted by Bylaw No. 2221

-Class # APPLICATION FOR

Lic. # BUSINESS LICENCE

PLEASE PRINT IN BLACK INK

Application is hereby made for a Business Licence. The’ following information concerning
the applicant and business fs submitted. . '

NAME OF BUSINESS

NAME OF CORPORATION OR INDIVIDUAL WHICH OWNS BUSINESS:

OWNER'S MAILING ADDRESS POSTAL CODE

BUSINESS LOCATION:

BUSINESS TELEPHONE . OWNER'S TELEPHONE

APPLICANT'S NAME DATE OF 8!RTH

STATUS OF APPLICANT (OWNER , MANAGER , AGENT)

If Corporation owns business, Name of President

Have you held a Business Licence Before? yes/no
Date Issued / / Where?

Has your Business Licence ever been cancelled, refused or suspended? yes/no
If so, why? _ . :

~

DESCRIPTION OF BUSINESS ACTIVITY

NUMBER OF PERSONS WORKING IN BUSINESS Emp ! oyees

' BUSINESS PREMISES IN PORT COQUITLAM:

Floor Area in Sq. Metres: © Starting Date
Restaurants and Beverage Rooms; Seating Capacity
Barber and Beauty Parlours; No. of Chairs _.. and Operators
Poo! Rooms and Bowling Alleys; No. of Tables or Alleys
Vending Machines Numbers

FITNESS AND RECREATION FACILITIES

No. Handball, Racquetbai | and/or Squash Courts
No. of Gyms and/or Weight Rooms _
No. of Saunas and/or Whirlpools

RENTAL UNITS
Type and Number of Rental Units:

Rooms Hote! /Mote | Industrial Bays

Apartment Suites Apartment Batchelor One Bedroom__ Two Bedroom _. Three Bedroom

Name of Manager . Telephone
Business carried on from premises outside Port Coquitlam (Non-Resident Business)
Starting Date. / / Certificate Type and No.

Temp eBusiness Licence

1237
13 43

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