OCCUPATIONAL TAX CERTIFICATE ZONING VERIFICATION
City of Chamblee Planning & Development Department
5576 Peachtree Rd, Ste 102 Chamblee, GA 30341 • 770-986-5010 chambleega.gov
APPLICANT
______________________________________________________________________________
Applicant Name
_____________________________________________________________________________
Mailing Address Suite/Apt. # City, State
Zip Code
_________________
Primary Phone #
_________________
E-mail
BUSINESS SUMMARY
______________________________________________________________________________
Address of Business
______________________________________________________________________________
Name of Business
INTERIOR RENOVATIONS:
Yes
No
TOTAL SQUARE FOOTAGE: ________ CURRENT USE: _____________________________________________________
DETAILED DESCRIPTION OF PROPOSED USE:
_______________________________________________________________________________
_______________________________________________________________________________
I, the applicant, understand that I am required to conform to all applicable requirements of the
Unified Development Ordinance for the City of Chamblee and all other applicable laws and
ordinances that may apply to the above proposed use description. Failure to do so may be grounds
to revoke this Occupational Tax License or to deny any future permits that may be issued for this
business activity.
OFFICE USE ONLY
ZONING:
Date
DATE:
YES
NO
SUPPLEMENTAL USE STANDARDS:
STAFF:
Rev 8/12/19
YES
NO
Signature of Applicant
USE:
STOREFRONT STREET:
YES
NO
REASON IF NO:
HOME-BASED OCCUPATION:
Yes
No
REQUEST (check all that apply):
Change of Owner
Change of Location
Change of Use
Adding a Use
New Business
You can now email this form to chambleedevelopment@chambleega.gov for submittal.
(requires a building inspection)
PERMITTED:
click to sign
signature
click to edit
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