2. 
3. City of Ponca City

   Development Services Department
   516 E. Grand
   PO Box 1450
   Ponca City, OK 74602

   Phone 580-767-0383

   Fax 580-767-0325

   
   

5. Occupancy Certificate Application

7. Date:
11. Declaration
13. I (name)*
14. Of (address)*
15. City*
17. State*
18. Zip*
19. Phone #*
21. Declare that I am the:

    1. Registered Owner

    1. Authorized Tenant of the Registered Owner
25. Business Name*
26. Phone #
28. Use/or Intended Use:
30. Business Address:
31. Owner of Property
33. Property Owner's Address
35. 1. Was the building previously used for the same type of business/activity?*

    1. Yes

    1. No
37. 2. Is the building currently occupied?*

    1. Yes

    1. No
39. 3. Are you planning to alter the building structure by adding, removing, or cutting into any walls, or by performing work which could affect any load-bearing elements?*

    1. Yes

    1. No
41. 4. Are you planning to repair/upgrade the building’s plumbing, electrical, or mechanical systems in any way?*

    1. Yes

    1. No
43. 5. Have you verified that the property is zoned for the proposed usage?*

    1. Yes

    1. No
45. 6. Have you, or your agent, inspected the building to see if there exist any potentially unsafe conditions?*

    1. Yes

    1. No
47. 7. Will the owner of the building allow you to make necessary repairs to bring the structure into compliance with local codes?*

    1. Yes

    1. No
49. I understand that full occupancy of this building is not permitted until all prescribed inspections have been completed. Inspections are required when the new occupancy will involve: (1) a change of use, or (2) alterations to the building structure or systems. I further agree to obtain any necessary building permits, & to notify the inspector’s office when building alterations have been completed, and before I occupy the building.
51. Applicant's Signature
52. Projected date of occupation:
Leave This Blank:


54. 1. Receive an email copy of this form.
55. Email address

    This field is not part of the form submission.

56. Submit

* indicates a required field