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2. Business Information
4. Trade Name (DBA)*
8. Location of Business
10. Business Address*
12. City*
13. State*
14. Zip*
18. Mailing Address
20. Mailing Address 1*
22. Mailing Address 2
24. City*
25. State*
26. Zip*
30. Phone Number*
31. Fax Number
32. Email Address*
34. State Sales Tax I.D.*
36. Certificate of Good Standing*

    Please supply the Town with a copy of your Certificate of Good Standing.

40. Business Owner Information
42. Owner's First Name*
43. Owner's Last Name*
45. Owner's Email Address*
49. Owner's Address
51. Owner's Address*
53. Owner's Address 2
55. City*
56. State*
57. Zip*
61. Property Owner Information
63. Property Owner's First Name*
64. Property Owner's Last Name*
66. Property Owner's Email Address*
70. Property Owner's Address
72. Property Owner's Address 1*
74. Property Owner's Address 2
76. City*
77. State*
78. Zip*
82. License Information
84. Do you own the building where the business is located?*

    1. Yes
    2. No

86. If No, please provide the following:

88. Length of Lease
89. Building Owner Name
91. Building Owner's Address 1
93. Building Owner's Address 2
95. City
96. State
97. Zip
101. Please describe your daily business operations and how you plan to utilize the site. (2 – 3 Sentences): *
103. Is this a home based business?*

     1. Yes
     2. No
104. Type of Business*

     1. Retail
     2. Manufacturing
     3. Service
     4. Warehouse
     5. Office
     6. Other (please describe)
106. Other (please describe)
110. Total Square Feet of Building*
111. Square Feet Occupied by Business*
113. Square Footage Breakdown of use. E.g. office, warehouse, or storage space: *
115. What is the Zoning for this Business location?*

     If you have questions regarding zoning, please contact the Planning Division with questions 720-382-5610

117. Is this a new business to Frederick OR a new location within Frederick?*
119. Date business opened at this location
123. Maximum number of customers on site served at one time*
125. Please list the total number of parking stalls on site*
126. Handicap Parking stalls*
128. Is there public or other parking available?*

     1. Yes
     2. No
130. If so, how many spaces
131. and distance from business to public parking
133. Number of Full Time Employee*
134. Number of Part Time Employee*
138. Will there be any new construction?*

     1. Yes
     2. No

     (Construction, alteration or repairs to the structure as well as electrical, gas, mechanical, or plumbing construction, alteration or repairs)

     (Please contact the Building Department to verify whether you need a permit for modifications to your location 720-382-5605) 

140. If so, please describe
142. Will there be a new sign or temporary signs associated with the business?*

     1. Yes
     2. No

     Please be advised that there are specific regulations regarding signs in the Town of Frederick. See Article 7 of the Land Use Code for details.

144. Will there be overweight vehicles used in conjunction with the business?*

     1. Yes
     2. No

     Please be advised that overweight vehicles require permits issued by the Engineering Department.

146. Typical hours of operation*

     Note that our lighting code limits illumination of exterior lighting to one hour before opening and to one hour after business closing

148. Would you like to be included on the Town of Frederick’s Online Resource Directory?*

     1. Yes
     2. No
150. If yes, please provide website link.
154. Signature*

     I declare under penalty of perjury in the second degree that the statements made in this questionnaire are true and complete to the best of my knowledge. 

155. Title*
156. Date*
     Date
160. Date*
     Date
161. Name of Business*
163. Business Address*
165. City*
166. State*
167. Zip*
169. Mailing Address 1*
171. Mailing Address 2
173. City*
174. State*
175. Zip*
177. Business Phone Number*
178. Email Address*
180. Alarm*

     1. Yes
     2. No
181. Alarm Company
182. Alarm Company Phone Number
184. Any particular hazards at this address?*
188. After Hours Contacts
190. After Hours Contacts Name
191. After Hours Contacts Home Phone Number
192. After Hours Contacts Cell Phone Number
194. After Hours Contacts Name 2
195. After Hours Contacts Home Phone Number 3
196. After Hours Contacts Cell Phone Number 2
198. After Hours Contacts Name 3
199. After Hours Contacts Home Phone Number 3
200. After Hours Contacts Cell Phone Number 3
Leave This Blank:


202. 1. Receive an email copy of this form.
203. Email address

     This field is not part of the form submission.

204. Submit

* indicates a required field