2.  

   Please provide the information requested below at the time a Certificate of Use and Occupancy is issued, it will be forwarded to the Police Department and maintained on file by the City for utilization for emergency purposes only and is kept confidential.
   
   Select one of the choices below to indicate that this is an original form submittal or a corrected information submittal.

4. Form Submittal Type:*

   1. Original Form Submittal
   2. Corrected Information Submittal
6. Business Name:*
8. Business Address: (i.e. - 900 W. Liberty Dr. Wheaton, IL. 60187)*
10. Business Phone:
12. Business Email:
14.  
    PERSONS TO BE NOTIFIED
16. First Name: 1*
17. Last Name: 1*
19. Cell Phone: 1*
20. Email Address:1
24. First Name: 2
25. Last Name: 2
27. Cell Phone: 2
28. Email Address:2
32. First Name: 3
33. Last Name: 3
35. Cell Phone: 3
36. Email Address:3
38.  

    In the event that my business premises is found unsecured after business hours, do you give approval for Wheaton Police Department Officers to conduct an inspection of your business premises without your presence or that of your agent? Please note: If you do not agree, officer(s) may not remain at the premises until your arrival or that of your agent at the premises.

40. Police Inspection Agreement:*

    1. Yes
    2. No, and I understand that officers may not remain on the premises until my arrival.
42. Owner/Manager Signature: *
44. Verify Signature*

    1. I understand that checking this box constitutes the legal signature confirming the information entered above.
46.  

    This information will be stored in a secure database that can be accessed by authorized users from other City of Wheaton Depts. for official use only.

Leave This Blank:


50. 1. Receive an email copy of this form.
51. Email address

    This field is not part of the form submission.

52. Submit

* indicates a required field