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�o� o�-r�o <br /> CITY OF EVERETT � <br /> Clerk's Office <br /> 293n Wetmore Avenue <br /> Everetl WA 98201 �;,:T <br /> �...., . <br /> a00 S' <br /> PUBLIC DANCEHALL LICENSE APPUCATION 2(3A� <br /> Gate: Y/�l� — <br /> Business name: �R4, U-C d� 'r^'�S'hcl <br /> Business address: Z C�1 ' rnie f <br /> eusiness phone: (��S) `r39 �llll <br /> Applicant is Sole proprietor <br /> � Unincorporated association, partnership or corporation <br /> • Attach a list of names, home and business addresses and phone numbers ol <br /> all o/ficers, limifed partners, and directors thereo(. <br /> Operator (Manager's) name: �/ 1 ��r �mPfo/1 <br /> Home Address: 1� _ �y �'r • S�• ����� Wp'�012 <br /> Phone: (�O�o)� — <br /> Property owner name: �ob����4W <br /> Home address: <br /> Phone: ( ) —_ <br /> Bus�ness address: PO BOt� �3��i� GJelou� �1A 4�r� � <br /> Phone: ( ���5) _ �- — .5�74- <br /> • Applicant must provide tfie following infom�ation, which must be attached fo <br /> and made a part of tliis application. <br /> 1. A wrilten stalement setting forth all measures used to insure adequate <br /> tra(fic control anc' crowd protection, both within and without the premises, <br /> will be maintained; <br /> 2 Proof of indemnifir,ation and insurance is required by Seclion 5.20.150 for �p�- Q uin� <br /> public dancehall licenses for teen dances; <br /> 3. A statement from the applicant that the premises are in compliance with ail <br /> city law^ inciuding, but not limiled to, building, zoning, noise and fire codes. <br /> d. Four (4) copies of scaled floor plan oi the premises <br /> 5 List uf all e�nplo� ees including full name, date of birth, state identi(ication <br /> number, home address, and home phone number. (To be updated when <br /> personnel hired and/or fired) <br /> /' � <br />