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2. Date
3. Folio No.
5. Select:
   -- Select One --STR
7. BUSINESS INFORMATION
9. Name of Business/ DBA
11. Business Address
12. Zip Code
14. Phone Number
15. Business Fax Number
16. Square Footage
18. Applicant's Name
19. Applicant's Email Address
21. Type of Business
    Please describe in detail.
23. Type of Business

    1. Home Office
    2. Medical Office
    3. Admin. Office
    4. School

    1. Reail
    2. Restaurant (take-out)
    3. Restaurant (enter SF below)
    4. Other
25. Restaurant Patron Area SF
    Enter square footage for patron area
26. Restaurant Back of House
    Enter square footage for the back of the house area
28. Previous Type of Business
    Describe the previous type of business in the location in which you will conduct your business.
30. PERSONAL INFORMATION
32. Corporate Officer/ Owner:
33. Title
35. Address
37. City
38. State
39. Zip Code
41. Submission by the applicant & landlord verifies the above information is true and correct. Parties understand the Certificate of Use is being approved and accepts that no charges or refunds can be made once in process. Parties acknowledge that he/she is/are authorized to sign on behalf of the business and understand that any misrepresentation of information on this application may result in the revocation of the Certificate of Use and/ or possible enforcement action being initiated against the business and/ or its authorized representative. Parties further understand that a separate Certificate of Occupancy (if applicable) and Local Business Tax Receipt are also required. Parties agree to comply with all Federal, County and local laws.
43. I am the (select one)*
    -- Select One --ApplicantOwner
44. Enter Name*
46. I am the (select one)*
    -- Select One --ApplicantOwner
47. Enter Name*
49. Date and Time of Submission*
    Date and Time of Submission

    Date and Time of Submission
Leave This Blank:


51. 1. Receive an email copy of this form.
52. Email address

    This field is not part of the form submission.

53. Submit Submit and Print

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