Miami Dade County Department of Planning and Zoning Zoning Permits Section - 11805 S.W. 26 Street, Suite 106 Miami, FL 33175 – Phone: 786-315-2666 Application for Certificate of Use Date: __________________ Folio: _________________ Permit # ___________________ S_____ T_______ R_______ Business Information: Location Address: ________________________________ Unit/Suite: ______________ (List all addresses above) (List all unit numbers above) City: ________________ State: ____________ Zip Code: ______________________ Mailing Address________________________________________________________ City: ________________ State: ____________ Zip Code: ______________________ Name of Business/DBA: _________________________________________________ Corporate: ____________________________________________________________ Corporate Officer/ Owner: ___________________________ Title: ______________ Phone Number: _____________________ Size of Space (Sq. Feet) _______________ Fax Number: _____________________ Are you sharing spaces with another business? Will used merchandise be sold on the property? Office Home Office Apt # Yes _____ Yes _____ Retail Warehouse No ______ No ______ Wholesale Describe the type of business_____________________________________________ __________________________________________________________ Signature of applicant verifies the above information is true and correct. I understand the conditions under which my Certificate of Use (CU) is being approved and accept that no charges or refunds can be made once issued. I am authorized to sign for the business and understand that any misrepresentation of information on this application may result in the revocation of the CU and /or possible enforcement action being initiated against the business and/or it’s authorized representatives. I further understand that a separate Certificate of Occupancy (CO) is also required and is obtainable from the Building Department. x___________________________ x_________________________________ Print name Signature _____________________Fax application to 786-315-2928________________________________ Department use only: Zoning: _______ Processor: ___________________ Conditions under which approved: ______________________________ Resolutions: ________________________________________________ Process number: U_______________________ Certificate Number ______________________ American LegalNet, Inc. www.FormsWorkflow.com