Certificate of Occupancy
Application
Permit Number:
***Please Fill Out Application Thoroughly. Missing Sections Will Delay your Permit***
Site Information
Property Address: Suite #
Name of Business:
Reason for CO:
Business Use:
New Building
Alteration/Remodel
New Business in Existing Space
Change of Ownership
Change of Name
Retail
Restaurant
Service
Wholesale
Religious
Office
Industrial
Other
Total Sq. Ft.:
Restaurant Dining Area Sq. Ft.:
Business Information:
Business Owner:
Contact Name:
Mailing Address:
City/State:
Zip:
Description of Business (Services/operation of business):
Responsible Parties
Building Owner:
Office #:
Cell #:
Address:
City/State:
I CERTIFY THE ABOVE INFORMATION TO BE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE. FALSIFIED
INFORMATION MAY RESULT IN THE REVOCATION OF THIS CERTIFICATE OF OCCUPANCY AND THE ISSUANCE OF
MUNICIPAL CITATIONS. APPLICATION WILL EXPIRE AFTER SIX (6) MONTHS OF INACTIVITY (INCOMPLETE APPLICATION
MAY NOT BE ACCEPTED).
***ONCE YOU HAVE COMPLETED YOUR ELECTRICAL INSPECTION PLEASE CALL OUR OFFICE TO SET UP A C/O WALK-
THROUGH***
RESPONSIBLE PARTY/TENANT NAME:
SIGNATURE:
(Must be completed by Tenant/Business Owner NOT Contractor)
CONTACT PHONE: DRIVERS LICENSE #/STATE: DATE:
BELOW IS FOR OFFICE USE ONLY
RECEIVED BY:
FEE PAID:
APPROVED BY:
DATE:
OCCUPANCY LOAD:
CONSTRUCTION TYPE:
FIRE SPRINKLER:
Yes ❑No
OCCUPANCY TYPE:
10/
17
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signature
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