COVID-19 Temporary Use Permit

The purpose of a COVID-19 Temporary Use Permit is to encourage economic activity and assist local businesses impacted by the COVID-19 pandemic to ease back into operation while accommodating health guidelines currently in force within the State of Michigan.

This application and process are pursuant to the city commission's action of June 8, 2020. To read the resolution and for more information, go to romi.gov/covidpermit.

Business Name

Owner/Agent Name:

Phone Number

Please use these check boxes to confirm the plan you are uploading includes the following. (Omitting any of the plan requirements may delay the approval if your permit.)

Show all PROPOSED fixtures, furnishings and structures and existing components

Clearly dimension all items

Clearly depict separation, pedestrian pathways and compliance with social distancing guidelines

Identify the reductions in square footage, number of chairs/seats from existing interior to comply with social distancing

Identify the proposed exterior square footage, and proposed number of chairs/seats - this should not be more than the number removed from interior. Expansions will not be approved.

Click here to see a sample plan.

Upload a plan (PDF) detailing the layout of of the proposed activity or use:

Click Here to Upload

Describe the proposed activity or use:

Proposed days of activity or use. (Check all that apply.)

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Describe times of operation

NOTE: All temporary permits shall autimatically expire on October 31, 202 and uses/activities shall be removed or upon order of the city.

Does the proposed activity or use extend in front of another business or property?

Yes

Click here to see a sample affidavit document.

Please upload an affidavit document (PDF) from the adjacent business/property owner acknowledging said encroachment shall be provided. The document, which shall be notarized, must include the business/property owner's name, address, phone number and/or email and signature.

Click Here to Upload

Is the proposed activity or use planned for public property or right-of-way?

Yes

Proof of Insurance and a signed license agreement covering the proposed activity or use is required by the city when the activity or use is planned for public property or right-of-way.

Click here to see a sample 'Proof of Insurance.'

Insurance Policy Carrier

Insurance Policy Number

Upload copy of Proof of Insurance (PDF):

Click Here to Upload

Download a COVID-19 Special Land Use Permit - License Agreement here.

Complete and upload a signed COVID-19 Special Land Use Permit - License Agreement (PDF). See link above to download this document.

Click Here to Upload

NOTE: Someone from the city will contact you once your application has been reviewed.You cannot begin building out your proposed space until your application has been approved!

Having trouble filling out this form? Call Judy Davids at 248-672-5418