Diffley Rd_1016 #200_Barbershop zoning approvalPage 7 of 8
BUILDING AND ZONING COMPLIANCE
To assure that the Barbershop is in compliance with current local building and zoning ordinances,
this page must be completed for all Barbershop applications even if the location has been a
Barbershop before.
BUILDING AND ZONING COMPLIANCE STATEMENT TO BE
COMPLETED BY ZONING OFFICIAL, ORIGINAL
SIGNATURE REQUIRED
I attest that the barbershop located at 1C)16 j_ C� *V- ZCb
(Shop Address)
as identified in this application, is in compliance with local building and zoning requirements.
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Cit CouMy ofJurisdiction
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Signature of Zoning Official
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Printed Name of Zoning Official
CERTIFICATION OF APPLICANT
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Title Date
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Telephone
I certify that the information included within this application is true and correct. I also certify that this
document has not been altered or changed in any manner from the form adopted by the Minnesota Board of
Barber Examiners.
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Signature of Applicant Date
Subscribed and sworn before me thisd3 —c
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Printed Name of Applicant
Notary Seal
JULIE ANITA STRID
Notary Public-MinmaMa
My Conn "Eq*n don 31, 2025V -WV#%AANVVVVVVV1
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My Commission Expires: