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Business Occupancy

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Steps

1. Applicant Information(current) This section is complete This section is incomplete
2. Agreement to Defend, Hold Harmless & Indemnify This section is complete This section is incomplete

Applicant Information

PLAQUEMINES PARISH GOVERNMENT
PLANNING & ZONING DEPARTMENT
There may be a fee associated with this form. Once the form is completed if further details or clarification is required you will be notified.
CERTIFICATE NUMBER
DATE*
DATE
RECEIPT NUMBER
COUNCIL DISTRICT
TECH
ZONING DISTRICT
BUSINESS NAME*
BUSINESS OWNER*
ADDRESS*
PHONE NUMBER*
1. OFFICE
2. CELL
OFFICE #
CELL #
TYPE OF BUSINESS*
1. RESIDENTIAL
2. COMMERICIAL
3. INDUSTRIAL
4. OTHER
OTHER
PROPERTY OWNER*
PROJECT SITE*
DIRECTIONS TO SITE*
EXISTING BUILDING*
VACANT LAND*
DOES YOUR BUSINESS DO PAINTING OR SANDBLASTING?
1. YES
2. NO
DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIALS?
1. YES
2. NO
SPECIFIC USE/ BUSINESS ACTIVITY (IN DETAIL)*
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Agreement to Defend, Hold Harmless & Indemnify

ZONING ADMINISTRATOR
DATE
DATE
BUSINESS OWNER OR AGENT*
DATE*
DATE
EMERGENCY CONTACT*
PHONE #*
CELL #*
E-Mail*
I certify that the information supplied for this certificate is true and accurate to the best of my knowledge. The above signed applicant acknowledges that this certificate does not authorize any construction, remodeling, or build-out of above mentioned property. Any improvements to building or inspection has been made to this property; therefore this certificate does not imply any special knowledge to the structural integrity, safety hazards or code related issues that may exist at the above described property. This certificate does not attest to the suitability of the present structures to accommodate the proposed business use. Applicant also acknowledges that this certificate is not transferable, and any change in business ownership or business use will require a new certificate.
PLEASE NOT: THIS FORM DOES NOT REPLACE AND IS NOT INTENDED TO BE USED AS YOUR OCCUPATIONAL LICENSE.

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