Fillable Form 401 (City of Louisburg)

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Form 401 (City of Louisburg)

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BROWSE CITY OF LOUISBURG (KS) FORMS

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Building & Zoning Department
215 S. Broadway, Louisburg, KS 66053
913-837-5811 · louisburgkansas.gov
rwhitham@louisburgkansas.gov
Commercial Change of Ownership or Use
Application for Life Safety Inspection
Applicant’s Name: ___________________________________________________________________________________
Mailing Address: ____________________________________ City: __________________ State: ____ ZIP: ___________
Are you the property owner: ________ Yes ________ No
Phone Number: ____________________________________ Cell Number: _____________________________________
Email Address: ______________________________________________________________________________________
Business Name: _____________________________________________________________________________________
Business Address: ____________________________________ City: __________________ State: ____ ZIP: ___________
Applicant’s Signature: ______________________________________________________________ Date: _____________
The purpose of this two-phase inspection process is to ensure that all commercial buildings are periodically inspected
checking for fire and safety issues. The City Fire Marshall and the City Building Inspector will be conducting two separate
inspections of your building(s). The fee for both inspections is $50. This inspection process is initiated every time the
ownership or change of use of a commercial property has occurred.
Inspection Code Requirements:
The Building Inspector and Fire Department Inspector will conduct the inspection consultation to identify code
deficiencies that need to be corrected for future occupancy. The City of Louisburg has adopted the following codes:
· 2003 International Residential Code · 2003 International Fuel Gas Code
· 2003 International Building Code · 2002 National Electric Code
· 2003 International Mechanical Code · 2003 International Fire Code
· 2003 International Plumbing Code
If your building is undergoing remodeling through the building permit process, your $50 inspection fee will be deducted
from the permit fee.
You will be contacted directly by both inspectors to schedule your inspections. Inspections should be completed within
two weeks.
Please Contact the Louisburg Building and Zoning Department at 913-837-5811 if you have any questions.
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Business Contact Information
(Information for City Staff, Chamber of Commerce and Economic Development)
Name of business:___________________________________________________________________________________
Please use name registered or intended to register with State of Kansas)
EIN: _______________________________________________________________________________________________
Name of business owner: _____________________________________________________________________________
Business address: ___________________________________________________________________
Are you the business owner: ________ Yes ________ No
If not, please provide the owner’s name: _________________________________________________________
Business owner contact information
Name _____________________________________________________________________________________________
Mailing address: ________________________________________City: __________________ State: ____ ZIP: ________
Phone: _________________________________ Email: _____________________________________________________
Type of business/service: _____________________________________________ Number of employees: ____________
Are you a new business: _____ Yes _____ No Are you relocating? _____ Yes _____ No
If so, where are you currently located: ___________________________________________
Any plans for expansion? _____ Yes _____ No
Are you a multi-tenant or multi-business owner? _____ Yes _____ No
Will you sub-lease any space in this building? _____ Yes _____ No
Do you currently reside in Louisburg? _____ Yes _____ No In Miami County? _____ Yes _____ No
Are you aware of the following? Louisburg Chamber of Commerce _____ Yes _____ No
Miami County Economic Development _____ Yes _____ No
Do you know of other businesses that may be interested in relocating to Louisburg? _____ Yes _____ No
Have you requested/received any necessary state inspections? _____ Yes _____ No
If yes, can you provide a copy of your state inspection to the City?
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Form 401 (City of Louisburg)

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Completed 14 July 2020

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