City of Washington Change of Use Form
Inspections Division
252-975-9352 / 252-975-9304
Name of NEW Business:
Address of Business:
Name of Building Owner:
Type of Use:
(   ) Assembly (church, theater, restaurant, etc.)
(   ) Business (bank, clinic, office, barber, etc.)
(   ) Educational (school, child care, etc.)
(   ) Factory-Industrial (manufacturing, assembly)
(   ) Hazardous (cleaners, grainery, etc.)
(   ) Institutional (hospital, nursing home, etc.)
(   ) Merchantile (drug store, retail store, etc.)		 (   ) Residential (hotel, apartment, etc.)
(   ) Residential Non-commercial

(   ) Transitional (Temporary usage for a limited time; clean-up of building, painting, and other uses that do not require a permit of any type. Permanent tenant or usage requires proper zoning, building and fire approval and/or permits.)
Description of NEW Business (please be specific):
Name of FORMER Business at above address:
Name of Applicant: Phone #:
*It is understood that, if the use of the building is changed without prior approval from the Inspections Department, the City of Washington will take the necessary action to bring the structure into compliance. It is YOUR responsibility to contact the Fire Marshal at (252) 946-9402 to schedule a Fire Inspection within 24 hours of opening the business.
Signature: Date:
FOR OFFICE USE ONLY
Zone: ______________________     (   ) City    (   ) ETJ    (   ) Historic District
Is new use permitted in this zone?
(   ) Yes, by right.    (   ) Yes, with developmental standards    (   ) Yes, as a special use    (   ) No
*Note: If this use is permitted as a special use, a request for a special use permit will have to be approved by the City of Washington's Board of Adjustment after a public hearing.
Zoning/Historic: Date:
Fire Marshal:

Date:
Public Works: Date:
(   ) Application approved    (   ) Application denied     (   ) Application approved with conditions
Conditions:
Building Inspector: Date:
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