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11 1 2. As , i . i I i d I i c I at , e - d o 11 n 11 the -, chart, - en <br />nt 1 0 1. r I t I h e - i I ndividUals that pertain to your business type: <br />(1-oraddilional space, erre ("orr" L-0110) <br />Indiv - idl.1.9111ndividual owner Umited Liability Company/An officers or Managers <br />J6nt Venture/Venturers <br />Paftnersi"Jp/All Partners <br />L . irnfted I Partnership/All General Partners Trustffrustee(s) <br />I Corporation/All 0 1 ffic I :er I s City, County, University/Official <br />Last N I a I rn 1. e �11111 -1111-1-11- "Inst 1. t - Name 11 . MI 'Title <br />Ermir Member <br />METALIAJ <br />Last Name First NMI 'title <br />Member <br />BAJRAMI Bujar <br />11-1 — 1'-, <br />Fi I r I s, I t I N , a rn e MI Title <br />East t,,Iarne <br />MEASUREMENT INFORMATION <br />section 1 09 1 ct seq. <br />00 <br />VVili your business be located within 300 feet of a church or public hos pital?r-')Yes P40 <br />NOTE: Forchua,'heSor' public 1-rO,,jpitats ineasurefrom front doo"t0fr011tdoor„ rjjoragthG property hrler of the sire t rionis <br />a clitcct title act,()ss interseViolls. <br />- VVIII your I business be located within 300 feet of any private/public schooL clay care center or child care <br />14, facilityles, No <br />00) <br />-ire the facilities located on different floors or stories of the bUilding?ul <br />(es No <br />If "YES," <br />-oct line from tile nearest <br />scj7ools, day cal'o cellicys and chitd caro a dit <br />NOTE: For ptiva to jfjf.� rearest properly fine of the PIEWO Of <br />e conter or child carp facility <br />praj.,)erty firle Of tile sf,1700i, (Jay cat, <br />. y <br />sections.business, anio a dircwl It)(,' act'Oss 1171be wittlill 300 te - at- Child ca[O facility as 10119 as <br />,et of a Clay caro centet <br />NOTE: For inufliStOlY bUddit'91. t)(jsijtesse,,,i ina I <br />tire facijities are jr,)catod on differo.111 ROOT, Of it("n 9 <br />N TE: if I(Icatecl oil or above the fift)"I story, of a frivitistoly building: frie�asljre in a direct (tile from the ProftelfY Of the <br />0 f business if) a direct line across hate sections vedicallY uP <br />privateYpoWir school to tarn PO11Y title Of yoll". 1)'ace 0 WhICh yoLjr bustriess is located, <br />the building at 117e PrOPerly fine to the base Of1he OU <br />floor <br />1,000 feet of a I)rivate school'? ( ­)Yes No <br />,15. Will your business be located Within <br />'16. Will YOUr business be located within 1,000 feet of a public school'? Yes NO <br />-7, <br />-.7: 60 -DAY SIGN <br />Exact Date (MMIDDIYYYY) <br />'11.391 and 61.381 enter the exact date the 60- <br />As required under Section 04/18/2018 <br />Day sign was hosted at your location. - - - <br />ALL APPLICANTS <br />'18. IF YOUR LOCATION IS NOT WITHIN THE CITY LIMITS, CHECK HERE <br />1, the applicant, have col <br />Ifirmed I am not located in the city limits of any city and therefore all city <br />certificates are not required. <br />Page 2 of 5 Form, L -ON (12/2017) <br />