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2. 
4. PROPERTY INFORMATION
6. Address*
8. Address
10. City*
11. State*
12. Zip*
14. Parcel Number*
15. Zoning District*
17. Plat Name*
18. Lot Number*
20. APPLICANT INFORMATION
22. Company Name*
23. Phone Number*
25. Owner/Agent Name*
26. E-Mail*
28. Address1*
30. Address2
32. City*
33. State*
34. Zip*
36. USE INFORMATION
38. Name of Business*
40. Existing Use*
42. Explain the proposed use:*
44. The application will include a maximum of two building and two fire inspections. If more inspections are required, a fee of $50 per inspection must be paid prior to the inspections being conducted.
46. INSPECTION INFORMATION
48. Anticipated Move-in Date:*
49. Requested Inspection Date:*
51. Contact Name*
52. Phone *

54. It is the applicant's responsibility to meet the requirements of the Township zoning and general ordinances in all respects and to provide the necessary information to the Township for approval. Ordinances may be viewed online.  By signing, permission is granted for the Township Staff to enter the subject property for purposes of gathering information to review this request. A Zoning Compliance Certificate will be issued upon approval of this application. The Zoning Compliance Certificate must be obtained prior to occupying, operating, or use of the structure. I acknowledge there are no refunds for any reason.

56. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
58. Electronic Signature*
59. Date*
    Date
Leave This Blank:


61. 1. Receive an email copy of this form.
62. Email address

    This field is not part of the form submission.

63. Submit

* indicates a required field