ALCOHOL LIC t NORTH CAROLINA //coo 26 7,
ALCOHOLIC BEVERAGE CONTROL COMMISSION
4307 MAIL SERVICE CENTER
RALEIGH NC 27699 4307
* (919) 779 0700 FAX (919) 662 3583
-. www ncabc com
INSPECTION /ZONING COMPLIANCE
IMPORTANT The Applicant will complete SECTION A below SECTIONS through SECTIONE below are to be
completed by the appropriate Inspectton/Zonrng Ofcral To request inspections and zoning certifications please
contact the city or county and fire ins and zoning departments for your area Failure to submit this
form a timely manner to these local authorities may result in delays in processing of an ABC permit application
-,. This form must be completed by -the building fire and zoning officials before a permit will be issued
s r 4 w 4 4 '4
SECTION A APPLICANT TO COMPLETE a
f 1� � �� nI t� h
Name of Applicant CJv 4,8 vii 4 det he ( i 0100t r ,,,_, r � * 4 '
"45 ti- "\ .N. „ 313. }.4` 4 i s 5" "
t � Trade Name of Business 'C. E �( X L o pn ° " x &4z QS) > .3.
Address of Bus n 4 L) S M C4 o&ssIJ i.
4 4
h " �.,� a ) City # . l+,.e 1' ° 11.� Id I % 4 t County `, c e .-
M r P P h one #�tO) � blo Q QI ll? � �� !
o ) -1- __ ..:....
9 1' 4' 16 i ,,,i- ^t 'xh s. u.. 4; ,v`l y -j ' `� -, k '�a "' 41 41 a 4' X 4 ' 1 A k l
1 1 SECTIONB BUILDING INSPECTOR TO COMPLETE ,,, s ' 'x - i n r£ "; L. 4',. —
45 x, ,tea $ nk rr €" e i i' - 4 t Butldrng i ,- w r ,, ,, ., , ' ° "''a - 4 k ; S 4 3 `" at, . Budding is in ' ❑ Compliance 4 ❑ Non compliance* s ❑ Not Applicable
z 4 , (e.: Building Inspectors Name (printed) and Signature ,p t c , '5 34 �g
4 ,i5 354 3
/45/
s" ` � P h # ( ,. ) ` tI 1 Date Y ofln s pecti o n " h 3 ' " r
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al
* s l k�3 :a? w 4 .4w x- e. s- '444144 a ' 44 -444 4\ , r �^ 4 ` "4' 4 a x t'. ,' SECTION C FIRE INSPEC TO COMPLETE 4 ,s ' . 1/ 1
\ k Ft re C ode { s { r , t 1
al ,� Budding is is in ' ❑ Com Compliance ❑ Non com lian cek ✓4 e 4 t r
g p p ❑Not Applicable 4"
s, t ) 7 7)7 4 ' 4 4, k 3 45)444 533'5 rt :: 4 Y .' r
IFire Inspectors Name (printed) and Signature . s, u # ''
C 3 k e k k- ) l Sr) 4' 41 X 41 `
i Phone #40 )x s4 - ! "^ d Date of Inspection k b.( 47 s 1 4 s
r SECTION De ZONING OFFICIA TO COMPLETE " , z- -- Y 4 44 4
'4' " Z oning 4 1 , r ,, .4i `
Busyne is in 4 u ❑, Compliance 0 Non compliance* ❑ ?'Not'Ap p licable
Is business located in an Urban Redevelopment Area (Article 22 of Chapter 160A) 0 Yes ❑ No
If Yes has establishment been given notice that it is in an Urban Redevelopment Area and must comply
t with the requirements ofN C G S 18B 309 s ❑ Yes ❑ No
y i
�' 1 Zoning "`
Permitted uses in this zone x t' 2
m »41 17) 4 ' 4 .. -- 1' '' h 4' r
4 i ' Zoning Official Name (pri»tedJ and Signature `' 4 '
Phone # ( ) Date of Inspection i.
r "+' ` ,%, f Please state reasons for 4 Noncomplrance, rn SECTION E on back of this page .,
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