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Will this equipment be used within a thousand (1,000) feet of a residential area? Yes No
(If yes, attach petition form, signed by at least 70% of the tenants or owners occupying such dwellings)
Will noise be emitting from a stationary or moving vehicle? Yes No
If yes, what area(s) of the city do you plan to operate in? (If applicable)
If you are operating from a stationary vehicle, give a general description as to the location and size of the area: (If applicable)
VEHICLE INFORMATION (If applicable)
Year: Make: Model:
Please be advised this section is voluntarily optional and exists for the convenience of the applicant:
The applicant expressly authorizes the Licensing Division of the City of Columbus, Department of Public Safety to contact the
Income Tax Division of the City of Columbus - City Auditor and in turn expressly authorizes the Income Tax Division of the City of
Columbus - City Auditor to provide access to the Licensing Division of the City of Columbus, Department of Public Safety current
municipal tax information related to the applicant listed above in relation to the Short-Term Rental Permit for which application is
being made. Any information provided to the Licensing Division will be held in strict confidence at all times and shall not be
disclosed to any other department or division of the City of Columbus, nor used for any other purpose other than as stated.
All information contained in this application is subject to disclosure as a matter of public record. Any
false statement made or given in this application shall result in denial, revocation, or future revocation
of the license under Columbus City Code Chapters 501 and 540, and may be referred for criminal
prosecution under Ohio Revised Code Chapter 2921.13 (A-3).
State of Ohio, County of Franklin
I, _____________________________________, being duly sworn, affirm and swear that I am the
(Print Applicant’s Name)
individual making the foregoing application; that he or she is knowledgeable with respect to that
which is to be licensed and to the information contained in the application; that the answers,
statements, and allegations made in this application are true and accurate to the best of my
knowledge and belief; and that I am an owner/operator/applicant of that which is to be licensed by
Sworn to before me and subscribed in my presence this ____ day of ___________________, 20____.
Notary or Agent of Director of Public Safety
The application must be signed, dated and notarized.