LAND AND BUILDING USE DECLARATION
(To be completed by the occupant/tenant)
Name of Establishment (Occupant): ______________________________________________________________________________________
Address of Property: __________________________________________________________________________________________________
Description of Main Use or Activity: ______________________________________________________________________________________
List of other uses or activities: ___________________________________________________________________________________________
Has there been any construction, alterations or renovations at the subject premises since the previous license issuance? Yes m No
1
) Please answer all of the following questions:
a)
Will the use include retail sales? Yes No
Percentage (%) of Floor Area devoted to retail sales _______%
If you answered yes to the above, will
all of the commodities you retail be
products of the main use or activity?
Yes
No
Yes
No
Yes
No
Yes
No
Yes No
b) Will the use include wholesale sales?
c) Will the use include the repair or servicing
of equipment/appliances?
d) Will the use include the repair or servicing
of motor vehicles?
e) Will there be any outdoor storage of
vehicles, goods or materials?
f) Will there be any
outdoor display of
vehicles, goods or materials?
Yes No
g) Is t
here an outdoor patio associated with
an eating establishment?
Yes
No
h) Will food be sold to the public for immediate
consumption on the property?
Yes
No
i) Will food be sold for take-out?
Yes
No
j) Are any of the following activities being
proposed at the subject location?
Yes
No
□ wood working
□ spray painting
□ welding
□ commercial cooking
□ use of compressed flammable gases
k) Total number of staff: Male __________ Female _________
2) Identification of Hazardous/Dangerous Materials
Please identify by Trade name and substance, all hazardous/dangerous materials that are used/stored on the premises. If additional space is
required please attach a separate list to this form.
□ check here if no hazardous/dangerous materials are used/stored on the premises.
Trade Name Substance
a)
___________________________ ______________________________________________________________________
b)___________________________ ______________________________________________________________________
c)___________________________ ______________________________________________________________________
d)___________________________ ______________________________________________________________________
e)___________________________ ______________________________________________________________________
3) Declaration
I, ______________________________________________________________________certify that:
(print name in full)
1) The information contained in this application, attached schedules, attached plans and specifications, and other attached documentation is
true to the best of my knowledge.
2) I have authority to bi
nd the corporation or partnership (if applicable).
________________________________ ____________________________________________________________________________
(date) (signature of applicant)
Personal information on this form is collected under the legal authority of the Municipal Act, R.S.O. 1990, M45 (as amended) and the Building Code Act, S.O. 1992,
C23. This information will be used to process the Permit Application. As a public record, information contained on this application and the documents required to
issue a building permit may be disclosed to any individual under the Municipal Freedom of Information and Protection of Privacy Act. Questions about this
collection should be directed to the Manager of Customer and Administrative Services, 2141 Major Mackenzie Drive, Vaughan, Ontario L6A 1T1 (905) 832-8510.
Building Standards Department
2141 Major Mackenzie Drive Vaughan, ON L6A 1T1
905-832-8510
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