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Business Tax Receipt Application

  1. Type of Business
  2. Contact for Fire Inspection (Not applicable to home-based business):
  3. Notice to Property Owner/Tenant:*
    Any alteration to the building will require a building permit and inspections for compliance with adopted City Building Codes. This includes wall partitions and wall coverings such as electrical, plumbing, and/or mechanical work. In addition, a building permit will be required for any ground or wall mounted sign erected or altered at this location.
  4. Transferability:*
    Approval to conduct a business is not transferable from one person to another or from one location to another.
  5. Applicant*
    I certify that all of the information herein is true and correct to the best of my knowledge and belief. If any portion is found to be false or misrepresented, such fact may be just for immediate revocation of any license issued to me. It is further understood that I must comply with all codes in the City of Cocoa and failure to correct conditions, which are in violation, is punishable under the code of sufficient cause for violation of my license. I acknowledge that the issuance of this will be preformed and should deficiencies be found that are in conflict with the city code, I will make the required corrections and pay the applicable fee(s).
  6. I understand that this constitutes a legal signature and confirms that I agree to the above terms.
  7. State of _________________
  8. County of _______________
  9. Sworn to (or affirmed) and subscribed before me this ____ day of ___________, 20____, by: ______________________________ has produced ________________________.
  10. Notary Public Signature ____________________________
  11. Name of Notary (typed, printed or stamped) _______________________________
  12. Property owner Signature (or submit a copy of a notarized lease)
    I certify that I am the simple owner (or legal representative of the property at)
  13. And I hereby give authorization to this applicant to operate the above-referenced business on my property as described above
  14. By typing my name in this form, I affirm the accuracy of information provided on this application. I understand that this constitutes a legal signature and confirms that I agree to the above terms.
  15. State of _________________
  16. County of _______________
  17. Sworn to (or affirmed) and subscribed before me this ____ day of ___________, 20____, by: ______________________________ has produced ________________________.
  18. Notary Public Signature ____________________________
  19. Name of Notary (typed, printed or stamped) _______________________________
  20. Leave This Blank: