Supplemental Business License Questionnaire Form - Henrico County Permit Center - Virginia
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2SUPPLEMENTAL BUSINESS LICENSE QUESTIONNAIRE
A
A
**COMPLETE FOR HOME OCCUPATION / HOME OFFICE ONLY**
Licensee Information
Description of Business
Be as COMPLETE AND SPECIFIC as possible.
______________________________________
____________________________________________________
Name of Licensee
____________________________________________________
______________________________________
____________________________________________________
Trade Name
____________________________________________________
______________________________________
Address of Home Office in Henrico County
____________________________________________________
______________________________________
____________________________________________________
Business Phone
__________
Please Complete the Following:
Keep in mind that these questions pertain to business activity in your home.
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Does the licensee live at the street address where the business will trade?
Yes
No
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Will anyone work at the home business that does not live in the home?
Yes
No
Does the licensee own the dwelling? If not, the owner or his agent must sign:
I, the owner, authorize use of the property for the business described above.
_________________________
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How will services be offered?
By appointment only
To the general public (walk-in)
Area (square feet) of main floor of dwelling
Area used for business purpose
: _____________
: ___________
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Will the business require external or internal additions or alterations to the home?
Yes
No
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□
Will the business use a detached accessory structure (garage, shed, etc.) for any purpose?
Yes
No
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Will the business use machinery or equipment not customary for household purposes?
Yes
No
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Will stock-in-trade (other than handicrafts made on the premises) be kept at the home?
Yes
No
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Will products (other than handicrafts made on the premises) be sold at the home?
Yes
No
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Will there be group instruction, assembly, or activity in the home?
Yes
No How many people?____
__
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Will there be any indication from the exterior that the home is used for a business?
Yes
No
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Will commercial vehicles be stored at the home?
Yes
No How many?
Empty Weight:
_____
_______
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Will any commercial trailer or tow truck or wrecker be parked at the dwelling?
Yes
No
The responses provided on this form are true, correct and complete. I understand that incomplete information may
result in processing delays, and further understand that false or misleading information may be grounds for legal
action.
_______________________________________________
__________________________
Signature of Applicant
Date
OFFICE USE ONLY
GPIN: _______________________
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ZONING: ______ PROFFERS CHECKED: ___________
APPROVED
REJECTED BY: __________ DATE: __________
COMMENTS:___________________________________________________________________________________________
______________________________________________________________________________________________________
_________
QUESTIONS CONCERNING SUPPLEMENTAL QUESTIONNAIRE:
Henrico County Permit Center, PO Box 90775, Henrico, VA 23273-0775, (804) 501-7280
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