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m D'ir'ections: This form roust be filled out wiih use of a typewriter or by printing in ink. if the appiiomion is by a natual person, by such person; if by aparinership, by one of the partners; if by a corporatio;i, by an officer, thereof; or if by an. unincorporated association, by the rnanager or managing officer thereof. PART I -LuE GENTRAL tl1.VTA'OR gI®rV Name of applicant Chipotle MexicanrGrill Co of loreoy. LC Business name: Cleotle Mexican Grill _._--..—. _--------------- Business address: 27()1. I-th_Ave..._Nl s Su., te._22.S,--S.t - nth-ony--_SW.l_ageA_ �_—ea2L Business phone: N tie t_..Iau wn-- 'f ypc of applicant: —_ Natual Person Partnership _ _ Corporation X Association or Other If business is to be conducted under a designation, name or style other than full i ndivicLial name ofthe applicant, a copy of the Trade Name Certi.ficatc, as requhud by l]nneso a StawosChapter333ceti`iedbytheelerkofdieDistrictComt.rrustbea ached. vie the exact legal descripioa of the pzemises to be Licensed. (Applicant must also submit a plot plan of flte area showiirg dimensions, location ofbnildiu)s, sucet access,pa ldrg fnciiiti s, and the locations of the distances To the scares, ch.schbr din g and public school grounds,) cription and site plan< The nearest church is How are the premises classified under the St. Anthony Zoning Ordinance? State full name, residence/business address and telephone number of owner or owners of the building wherein the licensed business will be located, iTowner is other than the applicant Individual or corporate name Home or business address Phone number Contact person W here the building is owned by other than applicant, state in summary the conditions of the lease agreement, such as, terms of lease, monthly rental, renewal privileges, etc. (A true copy Of the lease shall be attached) 1 term with two 5–year renewal tions. Monthly rent varies, T£build ng owned by individual applicant, ran preys p, corponat'ion or association, state. (_Attach a true copy of the Purchase Agreernent)