9-22-2: APPENDIX 2:

   APPENDIX 2

   WASHINGTON CITY

   TEMPORARY USE PERMIT

DATE:                TEMPORARY USE PERMIT NUMBER:           

APPLICANT'S NAME/TITLE:             

BUSINESS NAME:             

BUSINESS ADDRESS:              

Describe proposed activity - include type, duration, hours of operation, etc.:

Electricity needed: Yes      No      Food or Drink Yes     No     

ATTACH Site Plan: Show layout of activity - include area to be used parking, ingress, egress, streets, dimensions, etc.:

By my signature I hereby agree to obtain all necessary approvals and to comply with all conditions of this ordinance, and any special conditions attached to this approval. I further attest that all the statements made on this application are true and correct.

Applicant's Name      Property Owner Agent's Name

Signature         Signature

Address         Address

Telephone Number      Telephone Number

   For Official Use Only

Attachments:

	Site Plan		$        Deposit Req'd: Yes      No
	Health Permit		Receipt No.:
	Fire Approval
# of Parking Spaces Req'd			Comments/Special Conditions:
Zoning
Type of Sanitary Facility
Method of Dust Control			Approved by:
			Date:

 

(2007 Code)