To Be Completed by Applicant:
Food or Beverage Service Establishment Address:
Sidewalk Café Operator: Property Owner:
(if other than Operator)
Telephone # (Work): Telephone # (Work):
Telephone # (Home or Cell): Telephone # (Home or Cell):
E-mail Address: E-mail Address:
Fax Number: Fax Number:
I hereby certify that all information or documentation contained on or included with this sidewalk café permit application is true and
accurate.
I hereby certify that all city fees and taxes relative to the food or beverage service establishment owed to the City of Richmond have
been paid at the time of application.
I understand that any misrepresentation or falsification of the information or documentation contained on or included with this permit
application may result in revocation of the permit and that such revocation shall not be appealable.
Operator’s Signature / Date Owner’s Signature / Date
Sidewalk Café Permit Number: SC Date Issued:
City of Richmond Sidewalk Café Permit
Renewal Form
900 E. Broad Street Room 110
Richmond, VA 23219
(804) 646-4169
For Office Use Only
Renewal Submittal Requirements:
Proof of Indemnification/Insurance
Any changes to the approved permit requires the applicant to apply for a new Sidewalk Café Permit
Permit Renewal Fee / Outdoor Seating / Certificate Of Occupancy
Annual Renewal Fee is $100.00
Sidewalk Café permit: Total Outdoor Seating Allowed:
Current Certificate of Occupancy Permit Number:
Renewal Sidewalk Café Permit Application Approval
Director of Planning and Development Review / Date Director of Public Works / Date
Date Paid: Amount Paid: Receipt #
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click to sign
signature
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click to sign
signature
click to edit
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click to sign
signature
click to edit
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