Application for Change of Occupancy

Application for Change of Occupancy (Existing Structure)

Please note you will not be able to submit this form without a Proposed Floor Plan. For questions, please call the Building Department at 248-433-7715.

Address of Building *

Suite # *

Occupant/Tenant Name *

Occupant Contact Name *

Occupant Email *

Occupant Phone *

Corporate Address *

City *

State *

Zip *

Corporate Contact Name *

Corporate Contact Phone *

Emergency Contact Name *

Emergency Contact Phone *

Current Zoning of Building *

Prior Use *

Proposed Use *

Please Provide Floor Plan *

Please provide proposed floor plan including arrangement of furniture & all rooms labeled for their use

Number of occupants/employees proposed *

Gross square footage of building *

Number of parking places provided *

Interior/Exterior construction changes proposed? *

*If yes, additional reviews and approvals may be required for exterior changes to the building. Architectural, engineering, and proposed sign plans will be required prior to issuance of permits for any interior and/or exterior alterations to the existing building.

Yes*

Changes in signage proposed? *

Yes

By submitting this form, the parties acknowledge that this agreement is the same as handwritten signatures for the purposes of validity, enforceability, and admissibility.

Tenant Typed Signature *

Date of Tenant Signature *

I, the undersigned and owner of the building, do hereby acknowledge that I am aware of the Bloomfield Township Code of Ordinances relating to property maintenance, signage and litter, and further I understand that if I, or my tenant violate any part of the Code of Ordinances, I may receive a ticket with fines up to $500 for each violation.

Owner Acknowledgement of Code of Ordinances *

Check to agree.

Owner Typed Signature *

Today's Date *

After submitting this form, please complete the Bloomfield Township Police Department Emergency Contact Information Form.