Applicant Information

Business*

First name*

Last name*

Address*

City*

State*

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ZIP*

Phone*

Email*

Type of Home Occupation*

Attach additional information describing the occupation (optional)

Attachment

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Signature*

I acknowledge that I have reviewed and understand the Performance Standards for home occupations contained in Section 1011.12B of the Roseville City Code and understand that violation of the standards shall be grounds for revocation of my registration.