Applicant Name___________ Business Name (D/B/A)___________

Mailing Address___________ City_____ State_____ Zip_______

Telephone___________ Fax___________ Email___________

Public Property: Site Location:

1st Choice: Street Name_______ East Side_______ West Side_______

2nd Choice: Street Name_______ East Side_______ West Side_______

PLEASE ATTACH THE FOLLOWING TO THIS APPLICATION:

1.

Drawing of vending apparatus (drawn to scale with dimensions indicated)

2.

Drawing of signage (to scale)

3.

Application fee

4.

Evidence of ability to provide Certificate of Insurance for liability

5.

Trash plan

6.

Indemnification agreement

7.

Sales tax number

I hereby apply for a permit from the City of Cortez for the site specified in this application. I am familiar with the City of Cortez Land Use Code and hereby state that my vending activity will be consistent with the purposes and requirements of that document.

_____

FOR OFFICE USE (Indicate when received):

OTHER _____

Comments

_____

_____

_____

(Ord. 982 (part), 2003)