Section 1 of 1 in this document

Development Services Department Building Safety Division

CHANGE OF USE/NEW TENANT APPLICATION

1. Address of Property (Include Suite/Unit #):

2. Check all that apply:

Purchase of Property (buying the building/unit)

Purchase of Existing Business Operation/Leasing Space (taking over existing business from current owner)

Opening New Business/Leasing Tenant Space

3. New Business Name:

4. Anticipated occupancy date?

6. Building Owner Company

8. Building Owner Email address

9. Building Owner Phone Number

11. New Tenant/Business Company

13. New Tenant/Business Primary Contact Phone Number

14. New Tenant/Business Primary Contact Email Address

15. Total leased square footage of the space?

Click below to review the City Clerk's Licenses information:

https://www.bloomingtonil.gov/departments/city-clerk/license-permits

17. Is a City License or Permit required from the City Clerk's Office as part of the new business at this location?

18. Has the aforementioned application been submitted to the City Clerk at this time?

19. List immediately adjacent tenant spaces

20. Describe the Proposed Use

21. Former Use of Space

22. Maximum number of employees to be present at the busiest times of operation?

1-5

6-10

10+

23. Is a Fire Sprinkler system currently installed?

24. Is a Fire alarm system currently installed

25. Will the business involve the use or storage of chemicals?

Yes (Attach list of chemicals below and declare the maximum quantities to be present for each. Safety Data Sheets may be requested after application is processed.)

26.List of Chemicals If Applicable

27. Number of available off street parking spaces?

28. Shared parking spaces?

Yes

29. Will there be changes to permanent signage?

Yes (describe below)

30. Permanent Signage Changes (if applicable)

31. Will there be temporary signage?

Yes

32. List any and all interior and exterior alterations that are required or planned for the space including painting, carpentry, ceiling tiles, lighting, sinks, walls, plumbing, electrical, mechanicals, parking lot work, etc.

33. Floor plan containing all required information IMPORTANT Your application will not be processed without all required items included on the floor plan. Please review the previous page for requirements prior to submitting.

34. Floor plan upload (extra upload space if needed)

CERTIFICATION BY THE APPLICANT: By signing your name below, you certify that all the information contained in this application form, any attachments, documents, or plans submitted are true to the best of your knowledge and belief; and that you have approval from the owner of the property to proceed with this request. - I understand this application must be completed in its entirety and failure to do so will result in delay of review and application intake. - I understand additional information may be required to complete review of the application. The City reserves the right to request additional information to fully evaluate the request. - I understand I may not occupy the premises until a Certificate of Occupancy has been issued, and submission of this form does not grant or guarantee occupancy, or approval to perform building alterations.

Yes, I understand and agree to the above statements.

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First Name

Last Name

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I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

Development Services Department Building Safety Division

CHANGE OF USE/NEW TENANT APPLICATION

2. Check all that apply:

4. Anticipated occupancy date?

5. Building Owner Name

7. Building Owner Address

10. New Tenant/Business Primary Contact

12. New Tenant/Business address

16. Please indicate if any of the following services will be provided at the proposed establishment (Check all that apply)

22. Maximum number of employees to be present at the busiest times of operation?

25. Will the business involve the use or storage of chemicals?

26.List of Chemicals If Applicable

28. Shared parking spaces?

29. Will there be changes to permanent signage?

31. Will there be temporary signage?

33. Floor plan containing all required information *IMPORTANT* Your application will not be processed without all required items included on the floor plan. Please review the previous page for requirements prior to submitting.

34. Floor plan upload (extra upload space if needed)

Sign Here

33. Floor plan containing all required information IMPORTANT Your application will not be processed without all required items included on the floor plan. Please review the previous page for requirements prior to submitting.