Blair Pawn 2007"Application for Occupation License"
it of Blair
218 S. 16th Street
Blair, NE 68008
(402) 426 4191
The filing of this application or the granting of an occupation license neither confirms nor denies the use of the land as regulated under the provisions of the zoning
code, and is further subject to pertinent ordinances of the City of Blair which regulates and licenses specific affections and businesses.
Date:
Business Information:
Legal Name of Business J-1 /-A / P4 WA/
Common Name of Business
Business Address 16 V -5 City 13 4 ) /z -State &Z_ zip, C_SI'00)�
Phone Fax
Mailing Address (if different from above)
City — State Zip
Describe the nature of your business Pq t-V,11 S /Vo
Do you have a monitored Security and/or Fire Alarm System at the business address? Yes No
Will you be selling tobacco products at this business address? Yes No A .
Do you have music, vending, pinball machines or billiard/pool tables at this business? Yes No
Do you sell, or serve liquor at this address? Yes No )< -
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Primary Contact Name: P �1' U L_ /1 m c le- Phone V
Secondary Contact Name: 4; it z y wA c# -i-,E 4f . Phone � Z e_- -- S 3 's '?
13 D - 07 / // ON 7
I declare under penalty of false statement that to the best of my knowledge and belief the statements made
herein are correct and true.
Signature of Owner or Corporation Agent/owner v Title 0
OCCUPATION LICENSE REMITTANCE FEE
I hereby remit $ This is based on Section 10-902 of the Blair Municipal Code
Legal Description 0 C_
Date Paid: I Amount Paid: I Certificate # Assigned: