Business Occupancy Application Form

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This is the Town of Centreville Business Occupancy Application form (Rev. 8/28/2015). It requires applicant, business and property owner contact information, business location and trade name, descriptions of proposed alterations/renovations and materials/equipment, delivery arrangements, and whether hazardous materials will be used (if yes, an MDE permit must be attached). A $25 application fee is due with submission, incomplete applications may be denied, and the form notes that any sign or any alterations/renovations require separate permits; it includes signature lines for the applicant and the Zoning Administrator.

business occupancy Centreville application fee $25 alterations/renovations hazardous materials MDE permit sign permit property owner

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THE TOWN OF CENTREVILLE 101 LAWYERS ROW CENTREVILLE, MD 21617
410-758-1180 FAX 410-758-4741 WWW.TOWNOFCENTREVILLE.ORG
BUSINESS OCCUPANCY APPLICATION
Applicant must complete ALL of the following information (please print or type). Please be advised that an incomplete
application may result in the denial of an occupancy permit.
NOTE: $25.00 application fee is due at time of application.
Applicant/Business Owner: Home Phone:
Mailing Address: Business Phone:
Cell Phone:
Email address:
Location of Business/Organization:
Street Address City State Zip
Property Owner (if different from applicant):
Property Owner Address:
Street Address City State Zip
Name of Business/Organization/Trade Name/DBA: ______
Alterations/renovations proposed to the building:
Materials/Equipment to be used:
Will deliveries be made to the business? (cid:1) Yes (cid:1) No Frequency:
Will business involve the use of hazardous materials? (cid:1) Yes (cid:1) No If yes, attach copy of MDE Permit.
Emergency contact person & phone number:
Applicant’s Signature:
**ANY SIGN REQUIRES A PERMIT**
**ANY ALTERATIONS / RENOVATIONS REQUIRE A PERMIT**
Signature – Zoning Administrator Date
W:\0-PERMITS\APPLICATION Permit Forms\2015-Oct applications forms\Business Occupancy Application.doc Rev. 8/28/2015