Form 00340 - Certificate Of Occupancy Form Jule 2015
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1Certificate of Occupancy
Application to Establish Use
Date: ___________________ Name of Business: ________________________________________________
Address: __________________________________________________
Building #: ________ Suite #: ____
Sprinkler:
Yes
No
Unknown (If yes, provide a copy of the Fire Department Annual Sprinkler Inspection)
Fire Alarm:
Yes
No
Unknown (If yes, provide a copy of the Fire Department Annual Alarm Inspection)
Emergency Lights:
Yes
No
Unknown
Building or Suite area breakdown (in Sq. Ft.):
Retail: _____________________
Office: _______________________
Manufacturing: __________________
Kitchen: ____________________
Dining: ______________________
Warehouse: ____________________
Storage: ___________________
Other (specify): _______________
Total Lease Sq. Ft.: ______________
I am the owner (or an authorized agent acting on behalf of the owner) of the property at the address listed on this
application.
Applicant Signature: ___________________________
Print Name: ________________________________
Applicant Phone: _____________________________
Email: _____________________________________
-------------------------------------------------------- Staff Use --------------------------------------------------------
Initials: ____________
Permit Type: ______
Permit #: _________________
Permit Name: ________________________________
Project #: __________________________________________
C of O:
Yes
No
Citation:
Yes
No
Census: __________________
Qtr Sec: ________________
Cncl Dist: _________
Zoning: ___________
Units: ____________________
Occ Class: ______________
Const Type: _______
Struc Class: _______
Scope Code:
COFO 1 (Valid Permit in Records with NO COFO)
COFO 2 (No Permit in Records – Use established with other documentation)
COFO 3 (Permits in Records with incomplete inspection history)
Submittal or Permit (Please circle one and related Fee Code below):
Submittal: Research/Review Fee Code: BSCSTAFF (Please specify number of hours for review) ____
Permit: Permit Fee Code: BSCINSP (Please specify number of inspection disciplines) ____
Comments/Instructions: ______________________________________________________________________
Page 1 of 1
For more information or for a copy of this publication in an alternate format, contact Planning & Development at
602-262-7811 voice or TTY use 7-1-1.
S:\Certificate of Occupancy, Application to Establish Use
TRT/DOC/00340
WEB\dsd_trt_pdf_00340
Rev. 7/15
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Parent category: Financial