HomeMy WebLinkAboutPermit Certificate of Occupancy CO-23-13
180 Market Street South Burlington, VT 05403 tel 802.846.4106 fax 802.846.4101 www.sbvt.gov
Number CO-______-__________
(office use only) APPLICATION FOR CERTIFICATE OF OCCUPANCY
The undersigned herewith requests an inspection of the premises indicated below and issuance of a “Certificate
of Occupancy”, pursuant to Section 17.03 of City’s Land Development Regulations
1. PROPERTY STREET ADDRESS:
2. OWNER(S) OF RECORD (Name(s) as shown on deed, mailing address, phone)
3. APPLICANT (Name, mailing address, phone)
3A. Applicant email address:
4. IS THIS A HOME OCCUPATION REQUEST? □ Yes □ No (if yes, omit #5 & #6)
5. PERMIT INFORMATION: The work for which a Certificate of Occupancy is being requested was completed
on _______________ as authorized under Zoning Permit(s) # ZP-____-_____ dated ____________and
Associated Site Plan(s) # _______________ dated _______
6. This application must include either the RBES or CBES Certificate or a statement from the builder that this
requirement does not apply (Energy Code).
_________________________________ ___________________
Signature (Property Owner must sign for CO) Date
(office use only)
Date of Complete Application:
□ Temporary Certificate of Occupancy will expire on ____________ to provide the applicant time to
complete the following improvements: (see attached list)
□ Permanent Certificate of Occupancy
□ Application denied for the following reasons: (see attached list)
□ Approval includes as-built drawings
_______________________________ ___________________
Administrative Officer Date
The applicant or permittee retains the obligation to identify, apply for, and obtain relevant state permits for this
project. Call (802) 879-5676 to speak with the regional Permit Specialist.
1900 - 1930 Williston Road
Anne Audette, 67 Honeysuckle Lane, Williston, Vt 05495
Phone 802 871-5708 Email aaudette7@gmail.com
Anne Audette,67 Honesuckle Lane, Williston, Vt 05495
Phone 802 871-5708 Email aaudette7@gmail.com
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DocuSign Envelope ID: 0AA9FC16-4A55-4F0B-838E-F1D4F9A6E0BC
10/23/2023