Forms • Blaine • CivicEngage

Applicant(s) Name(s):*

Applicant(s) Phone Number(s):*

Address of Home Occupation:

Address:*

City:*

State:*

Zip:*

Mailing Address:

Same As Above:*

Yes

No (Complete Below)

Mailing Address:

Email Address:

Will there be any employees other than family members residing on the premises employed by this home occupation:*

Yes

No

Number of employees (including self):*

Will customer/clients visit your residence for the purpose of this occupation?*

Yes

No

If yes, how often?

Will there be pick-up from or deliveries to your residence due to this occupation?*

Yes

No

If yes, how often?

Will there be any exterior modification of your residence to accommodate this occupation?*

Yes

No

If yes, please explain.

Square footage of your residence:*

Square footage of area that will be used to conduct this occupation (cannot exceed 25% of residence):*

Detailed description of business operation:*

Please list any equipment that will be used on the operation of this business:*

Declaration:

IMPORTANT
You must read the attached Information Bulletin #18 before submitting this application.

Information Bulletin #18

I have read the attached Information bulletin #18 and agree that this application is in compliance with the requirements stated for a Home Occupation Permit. *

Yes

No

I declare that the above information is true and correct.*

Yes

No

Name as it appears on legal documents:*

* indicates required fields.

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