Type Full Name :
Sign With Hand
Telephone # *
Building Owner Name
Street Address
Email *
Federal ID #
Business Information
Secondary Telephone #
New Occupant Details
Complete Name
Sq ft of Basement
123 Main Ave, Your Town USA 90210
(555) 973-2212
Home Address *
Mailing City, State, Zip Code
Type of New Business
NOTE: Chapter 180-75 of the Town Ordinances requires that before the occupancy or possession of any building of structure may pass from one person to another a Certificate of Re-occupancy is required.
Telephone #
Business Name *
Alarm Company Name *
This application is for permission to occupy or use a building, structure or premises listed below for the following purpose of purposes
Annual Business Registration
24-Hour Emergency Contacts
Building Owner Information
Type of New Occupant
State *
Federal ID # *
Primary Telephone # *
Fee Schedule
Last Name *
Alarm Company Telephone # *
Complete Name
Complete Name
Telephone #
Telephone #
The fee for this application is $100.
Name of New Business
Primary Telephone #
Home Address
Applicant Signature
Business Owner Information
Description of Business *
First Name *
City *
Secondary Telephone #
Sq ft of Business
Email *
Zip *