1. Applicant’s Name:

2. Daytime Telephone/Fax Numbers including area codes:

Phone   Fax

3. Full Street Address of the dwelling unit in which the HBB operates:

Address :
City, Prov. :	Pickering, ON
Postal Code:

Mailing Address :  
if  same as above, check here

Address:
City:
Prov.:
Postal Code:

Lot:

Concession:

Plan:

Other:

Roll No.:

4. Are you a resident at the above address?

Yes        No

5. Are you the sole proprietor of the HBB?

Yes        No

6. Are you a partner of the HBB?

Yes        No

7. Are you a shareholder of the company operating the HBB?

Yes        No

8. Are you an officer of the company operating the HBB?

Yes        No

9. Are you an employee who uses your dwelling unit as your principal place of business?

Yes        No

10. What is the name of the company operating the HBB?

11. What is the name of the HBB?

12. Explain what type of work will be performed in the home?:

13. How many other people are or will be working at this location for this HBB?

14. How many of these other people also reside in the dwelling unit?

15. Is there a sign* for the HBB? (*Please refer to Sign By-law for applicable rules.)

Yes      No       Proposed 

What is the location of the sign ?

Wall ;    Door ;    Mailbox ;    Other

Is the surface area of the sign less than or equal to the maximum area of 800 square centimetres?

 Yes      No 

16. What is the total finished floor area* of the entire dwelling unit?
      (total finished floor area includes basement, if finished)

square metres

17. What is the total floor area of the HBB?

square metres

18. What percentage of the total dwelling unit does the HBB occupy?

%

19. Where in the dwelling unit is the HBB located?

Please describe :  

20. Declarations:

• I declare that the information provided on this form is true; and
  
• I will notify the City of Pickering should any of the circumstances described on the application form change, and understand that if there is any substantial change to the nature of the HBB, a new HBB license application and fee may be required; and
  
• I understand that misrepresentation constitutes fraud, subjecting me (and the HBB, if incorporated) to charges and the City’s revoking of the license; and
  
• I hereby acknowledge that all parking associated with the HBB, except for that of customers and clients, must be located on the lot; and
  
• I hereby agree to adhere to and follow the City’s zoning by-law, license by-law, and sign by-law provisions relating to home-based businesses; and
  
• I hereby attest that the operation of the HBB described on this application will not contravene any municipal, provincial, or federal law or regulation; and
  
• I hereby authorize a municipal law enforcement officer of the City of Pickering entry to the property for the purpose of conducting an inspection regarding this HBB license application between the hours of 9 a.m. and 5 p.m. standard time.

I understand and agree to the declarations outlined above.
Yes             No    

A $50.00 fee is required with this application. Your Credit Card information is required to process an electronic payment
Name of Card Holder
Card Type	Select from list Master Card Visa
Card Number
Card Expiry Date	(type MM/YY as shown on card)

Date Application Submitted   

APPLICATION NO. HBB-