Mayor Filmore York Town Manager Scott Kidd Town Clerk Jessica Brown Town Attorney William H. Flowe. Jr.  PLAC  COUNCIL MEMBERS Tyson Nixon Mayor ProTem Larry Coble Chris Compton JRJ Beard Don Herndon  Pibeity  Town of Liberty Business Information  Applicant's Billing Name Business Name Business Service Address Business Mailing Address (fdifferent). Business Phone Name and Phone of Business Owner Type and Description of Business State Contractor License # (ifapplicable)  Business Fax #  Fed ID#  DBA:  In accordance with Chapter 110.03 oft the' Town of] Liberty Code of Ordinance, this ordinance is enacted for business listing In addition, Chapter 110.03 is enacted fort the purpose of refusal or revocation ofal license. Issuance ofa license in accordance with this ordinance does not excuse: al licensee from compliance with any other applicable ordinance or statute. Businesses who fail to comply with Chapter 110.03 are subject to penalties outlined! in Chapter 110.99. Ihereby certify that Ihaver made inquiry concerning the regulation of the Town ofLiberty and the business tol be conducted and will fully comply with the requirements and with all town ordinance and state laws regarding the same. I understand that Iam subject to periodic inspections in accordance with NC General Statute 160A-424. FOOD: HANDLING ESTABLISHMENTS: A copy of Randolph County Health Permit must be attached before ABC: PERMITS, ESTABLISHMENTS: Copies of all temporary or permanent. ABC permits are required.  issuance of license.  Signaturer  Date:_  Town of Liberty e P.O. Box 1006 e 239 South Fayetteville Street e Liberty, North Carolina 27298  Phone (336) 622-4276 e Fax (336) 622-2665 e www.lberty-NC.com