CERTIFICATE OF OCCUPANCY APPLICATION FORMDate MM slash DD slash YYYY Business Name First Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code APPLICATION FOR CERTIFICATE OF OCCUPANCY FOR EXISTING BUILDINGS IN THE CITY OF KIRBY This application is to be used for all businesses located at an existing address within the city limits of Kirby. The application will be completed with the cooperation of the building owner and tenant. In order to expedite the completion of inspections and issuance of the Certificate of Occupancy, all items on this form must be answered clearly. Any items left blank or not stated clearly will delay the process IT IS UNDERSTOOD THAT THE ADDRESS WILL NOT BE OCCUPIED OR OPEN FOR BUSINESS WITHOUT THE ISSUANCE OF A CERTIFICATE OF OCCUPANCY. APPLICANT INFORMATION Is the building currently occupied? Yes No Will there be or has there been any alterations done to the structure? Yes No Is there an existing fire alarm system in the building? Yes No Is there an existing fire sprinkler system in the building? Yes No Is there an existing burglar system in the building? (Premises burglar alarm permit applications are available at the Police Dept.) Yes No Will alcohol and/or food be served? (a health inspection is required) Yes No Will the building be used as or have a children’s day care? (a health inspection is required) Yes No Previous (or current) business namePrevious (or current) type of businessZoning of the property (if known)Special use permits or variances?Square FootageWill there be any flammable or combustible materials stored in the building? (If yes, please provide list). Yes No What type of shelving will be used?APPLICANT CONTACT INFORMATIONType of BusinessBusiness Owner(s) (IF TENANT PROVIDE COPY OF LEASE)Phone NumbersBusinessHomeCellPropery Owner First Last Propery Owners Phone NumbersBusinessHomeCellCertificates or Licenses (Please attach copies, if applicable)Health In File Not Required Health FileMax. file size: 256 MB.Liquor In File Not Required Liquor FileMax. file size: 256 MB.Special Use Permit In File Not Required Special Use Permit FileMax. file size: 256 MB.Tax ID In File Not Required Tax ID FileMax. file size: 256 MB.Employer ID In File Not Required Employer ID FileMax. file size: 256 MB.Insurance In File Not Required License FileMax. file size: 256 MB.License In File Not Required Insurance FileMax. file size: 256 MB.Will there be any changes made to the structure and/or its surroundings? Please include electrical, plumbing, and mechanical. (PLEASE DESCRIBE IN DETAIL BELOW)** NOTE: ANY CHANGES, EXCLUDING COSMETIC, MADE TO THE STRUCTURE WILL REQUIRE LICENSED CONTRACTORS TO OBTAIN APPROPRIATE PERMITS. WORK MUST BE COMPLETED & FINAL INSPECTIONS DONE PRIOR TO ISSUANCE OF CERTIFICATE.Changes to structure or surroundings?Signature of Business Applicant (APPLICATION FEES: $180.00)112 BAUMAN STREET KIRBY, TEXAS 78219 | (210) 661-3198 | FAX (210) 661-4525 Δ
