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BUSINESS DESCRIPTION
DESCRIPTION OF BUSINESS ACTIVITY

Square Footage of Floor Area Occupied Within Premises: Gross:

If Accessory Home Based Business:

Square Footage of Office Space in House: Total Square Footage of House:

Total Number of Workers in Business: (including owners working in business)

Plumbing TQ: Gas TQ: Sprinkler TQ:

Number of On-Site Parking Spaces Allocated to your Business:

Name of Business Previously in Building:

Owner of Building:

EMERGENCY INFORMATION

In order to offer assistance to you the RCMP and the Fire Department request your co-operation
in supplying three emergency contacts in the event someone from your business is required in
such cases as insecure business premises, vandalism, theft, fire etc.

. | Phone:

Phone:

Phone:

Do you wish the R.C.M.P. to inspect your premises for security purposes or for property
identification? Yes No

| apply for a business licence in accordance with the particulars of this application and J declare
that these statements are correct. Neither I nor my business have had any previous business
licence revocation, suspensions or convictions with regards to the operation of any business. |
agree to comply with all Bylaws of the City of Port Coquitlam and the provisions of Part 1! of.

the Municipal Act.

Signature: Date:

APPROVALS REQUIRED BY BYLAW & LICENCING DEPARTMENT

ZONING BUILDING | BYLAW ____ OTHER____
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