Fill and Sign the Employees Service Agreement for Receipt of a Recruitment Form

D E P A R T M E N T O F C O N S U M E R & R E G U L A T O R Y A F F A I R S Application Instructions and General Information for Certificate of Occupancy GENERAL INFORMATION A Certificate of Occupancy ( C of O ) does not take the place of any license that may be required. For information concerning license requirements, contact the License Center, 1100 4th Street, SW, Second Floor, or by phone at 202-442-4311 or via email dcra@dc.gov. APPLICATION INSTRUCTIONS Lines 1 to 18 Lines 1 thru 18 asks information about the proposed business/occupancy. Please be very detailed in the information you provide. Indicate N/A (non-applicable) for items that do not apply. Lines 1 to 20 Line 1 Line 4 Line 5 Line 6 Line 9 Please make sure that the signatures, dates , telephone numbers and all information are legible. Please do not use abbreviations for street names. Be sure that you indicate the correct quadrant and show the zip code. If your business is incorporated verification is required from the Corporation Division. List name of corporation if business is incorporated. List members of a partnership when applicable. Corporation officers names as well as members of a partnership should be noted on line 6. Certificate will be issued to the Corporation or Owner. Applicants must identify the filing status of the application by checking one or more of the boxes shown, if the following items are applicable: Ownership Change: Check this box if you have recently obtained ownership of the business Load Change: Check this box if you undertake changes such as the number of occupants in a rooming house, community residential facility, boarding house, the number of units in an apartment, hotel or motel, number of classrooms, students, seating capacity in a restaurant, etc. Partial Occupancy: Upon request from the holder of a building permit, a temporary certificate of occupancy may be issued for part of the building before completion of the entire work covered by the permit, provided such part can be occupied without endangering life, public safety or welfare. If you desire to occupy a portion of a premises under construction, check this box. Use Change: Check this box if you changed the previous use of the premises. Please note that applicants who have changed the previous use of a premise must have at the time of filing the C of O application proof, that construction or renovation work has been approved by producing a building permit and/or final inspection approval form. You may call the Records Management Branch for more specific information at 442-4400 about all issued permits. (Over) DCRA ZONING HELP LINE 202-442-4576 dcra.dc.gov CERTIFICATE OF OCCUPANCY INSTRUCTIONS PAGE 2 New Building: Check this box if you have recently constructed a new building and now desire to occupy the premises. You are required to show proof that construction or renovation work was approved by producing a Permit Work/Occupancy Form. (See Occupancy Use Information.) Board of Zoning Adjustment: Check this box if you have appeared before the Board of Zoning Adjustment to obtain a variance or special exception. Indicate the B.Z.A. case number assigned. Line 10 In identifying the proposed use of your building or premises please be as detailed as possible about the type of operation, special equipment used, ages of kids and number of staff in any facility, etc. Line 11 Be as detailed as possible about the prior use of the premises as described in Line 10. A copy of an existing C of O is extremely helpful. Line 12 Denote the number of roomers, residents in a community residential facility, boarders in a boarding house, units in apartment, hotel, motel, seating capacity, etc. Lines 18 to 20 If an agent is submitting an application on behalf of the owner, the application must be supported with a completed Owner Authorization Form signed by the Business Owner and notarized by a Licensed Notary Public. Authorization Forms can be obtained at 1100 4th Street, SW, Second Floor Washington, D.C. 20024, Permit Intake Center. DCRA ZONING HELP LINE 202-442-4576 dcra.dc.gov D E P A R T M E N T O F C O N S U M E R & R E G U L A T O R Y A F F A I R S Application for Certificate of Occupancy Application Date: ________________________________________ APPLICATION FEE $33 NON-REFUNDABLE CERTIFICATE FEE IS BASED ON SQUARE FOOTAGE Receipt Number: ___________________________________ Cashier Number: ___________________________________ C of O Number: ____________________________________ Erasing, Crossing Out, Whiting Out, or Otherwise Altering Any Entered Information Will Void This Application INFORMATION on PROPOSED BUSINESS 1. Premise Address __________________________________________________________ Suite/Room No ___________________ 2. Business Telephone __________________ Fax Number __________________ Lot ________________ Square ______________ 3. Trade Name of Business _________________________________________________________________________________ 4. Is Business Incorporated? Y/N _________ Partnership? Y/N _________ Sole Proprietor? Y/N_________ New/Existing ________ 5. Corporate Name _______________________________________________________________________________________ 6. President _________________________ Vice President ____________________________ Secretary ______________________ 7. Sole Proprietor _____________________________________________________________________________________________ 8. Business Owner’s Mailing Address_____________________________________ Phone Number (daytime)___________________ INFORMATION on OCCUPANCY 9.