OCCUPANCY PERMIT APPLICATION
Date of Application*

MonthDayYear
Date
BUILDING OR SPACE TO BE OCCUPIED
Business Name*
Address to be Occupied*
ex. 1234 Main St, Overland
Business Phone*
BUSINESS OWNER INFORMATION
Business Owner Name*
(full name)
Business Owner Address*

Street Address

Street Address Line 2

CityState

Zip Code
Business Owner Phone*
Business Owner Email*
example@example.com
BUILDING OWNER INFORMATION
Building Owner Name*
(Full Name)
Building Owner Address*

Street Address

Street Address Line 2

CityState

Zip Code
Building Owner Phone*
Building Owner Email*
example@example.com
After Hours Emergency Contacts
Contact #1 Name*
(Full Name)
Contact #1 Phone*
Contact #2 Name
(Full Name)
Contact #2 Phone
Applicant Information & Signature
Signature of Applicant*

Clear
Print Full Name*
Applicant's Phone*
Applicant's Email*
example@example.com
This application must be accompanied by a non-refundable $100.00 application fee. This application does not authorize occupancy. An occupancy permit will be issued after an inspection assures that the occupancy has no violations.
Payment Information

Fees Due*

Occupancy Permit Application FeeThis fee is NONREFUNDABLE & covers the first inspection plus one (1) re-inspection if necessary.

$100.00

Subtotal

$0.00

Tax

$0.00

Total

$0.00

Company Name
Company Name on Card (if applicable)
Billing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Billing Phone*
Billing Email*
example@example.com
By signing below I hereby authorize Community Fire Protection District to charge my credit card for the amount shown above. I understand this fee is non-refundable.
Authorization Signature*

Clear
Please verify that you are human*
Should be Empty:

OCCUPANCY PERMIT APPLICATION

BUILDING OR SPACE TO BE OCCUPIED