THE CORPORATION OF THE CITY OF PORT COQUITLAM

2272 McAllister Avenue
Port Coquitlam, B.C. V2C 2A8
941-5411 - Local 238
APPLICATION FOR BUSINESS LICENCE

FILE NO.._WH_ 200

Application is made horewith for a Business Licence in support of which the following information concerning the applicant and the
business is submitted:

Business Trade Name: (Corporation or Personal)
WHITEHALL CHEVRON

Nf Corporation:
Name of President: Address of President:

Business Location: 2079 Lougheed Highway Telephone: 9445311

Business Mailing Address:._. Same _as above

. 7 ~ 8
Applicant's Name In Full: Peter Southward Home Telephone: 942-7938

Applicant's Home Mailing Address: 3431 Queenston Avenue, Coquitlam, B.C.
Position In Company: OWNER Date of Birth:. 26/5/46 SiN. 0/705 407 534

Full Description of Business Activity intended: CHANGE OF BUSINESS LICENCE FROM SERVICE STATION
TO SELF SERVE WITH SERVICE BAYS.

Have you held a Licence Previously? YES. Where: PORT COQUITLAM When:._2969 = 1974
no 7

Has Licence ever been cancelled or refused?
NUMBER OF PERSONS ENGAGED IN SUSINESS:
2

Principals: Regular (Full Time) Part Time
A PRESIDENT BUSINESS:

Floor Area: (square feo!) Commencement Date: ___.______.___ Certificate #
NON-RESIDENT BUSINESS: (Contractor, ate.)
Commencoment Date: Certificate #
RENTAL UNITS:

New Licence: ______—_____-.----. Re-application: _. SC Transfer:
Type and Number of Rental Units:

Rooms: ——_______.. Hotel/Motel —__.

Suites:

Bachelor 1 Bedroom _____ «2 Bedroom —..___.-_____. 3 Bedroom

Other

Name of Manager: Telephone:

Addrass of Manager:

Barbers & Beauty Parlours: No. of Chairs: Ne. of Operators:

Pool Rooms & Bowling Alleys: No. of Tables: No. of Alloys:

Vending Machines; 1¢ Only Machings: Other Machines

VUWo hereby make application for a licence in accordance with the particulars as above stated and declare that the above statement is true
and corroct, and Lunderstand that if | am granted the hcence apptied for, [must comply with each and every obligation contained in allLaws and
By-laws now in force, or which hereafter come into force in the City.

DATE: ... FEB. 1/80 SIGNATURE OF APPLICANT

“PT SOUTIIWARD
IT 1S AN OFFENCE TO MAKE A FALSE DECLARATION

OFFICE USE ONLY:
CLASSIFICATION: .SELE..SERy ICE ree:$74.00__ TRANSFER OF LICENCE NO.

DATE: FEB. 11/80 APPROVED:

Licancy Inspector