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SMALL BUSINESS INFORMATION

Yes! Please contact me at the Business Owner contact info above for more info about operating a small business

APPLICANT INFORMATION / SIGNATURE BLOCK

Name of Applicant

__________________________________________

(If Different from Business Owner):________________

Applicant’s Address and Contact Information

(If Different from Business Owner)

Street __________________________________________________________ Suite ______________

City __________________________________, State _______, Zip Code _______________ - __________

Office phone (

)_________________ Mobile (

)_________________, Email_________________________

FAX phone (___)___________________

I HEREBY CERTIFY THAT I AM AN AUTHORIZED AGENT OF THE BUSINESS OWNER, AND HAVE THE BUSINESS OWNER’S CONSENT TO

REPRESENT THE BUSINESS AND THE INFORMATION PROVIDED WITHIN THIS APPLICATION. I FURTHER CERTIFY THAT THE INFORMATION

PROVIDED IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT FALSIFIED INFORMATION MAY LEAD TO THE

REVOCATION OF THE CERTIFICATION OF OCCUPANCY AND THE POTENTIAL ISSUANCE OF MUNICIPAL CITATIONS.

Signature of Business Owner / Applicant____________________________________________________________

Printed Name of Business Owner / Applicant ________________________________________________________

Business Owner / Applicant’s Driver’s License Number and State ________________________________________

Business Owner / Applicant’s Date of Birth__________________________________________________________

OFFICE USE ONLY

PERMIT Number_________________________

SIC Code_______________

Special Conditions______________________________________________________________________________

Date Paid _________________ Receipt #________________ Received by_________________________________

Electric Release_____________ Gas Release______________ Water Release_______________________________

Date Entered ______________ Date Mailed______________ Entered by__________________________________

Date CO Expires if no Activity (90 Days of Inactivity)_________________

Zoning District________________ Specific Use Permit Required _________ Date SUP Approved_______________

Specific Use Permit Case Number______________________________________

Inspections Initial and Date:

Zoning / Planning __________________________ Building Official_______________________________________

Fire Marshal’s Office_____________________________ Inspector________________________________________

Building and Development ________________________ Inspector________________________________________

Code Compliance & Health________________________ Inspector________________________________________

Police Department _______________________________ Officer _________________________________________

(Convenience Stores to be in compliance with Chapter 60 Article I Euless Code of Ordinances)

FORM UPDATED 08/2014

Certificate Of Occupancy Application - City Of Euless Planning And Development Department Page 2