FOOTWAY ACTIVITY LICENCE APPLICATION
(Merchandise, Merchandising Racks, Trading Tables & Associated Equipment)
Roads Act 1993
Locked Bag 155, Coffs Harbour 2450;
Administrative Centre, 2 Castle Street, Coffs Harbour
Email: Phone: (02) 6648 4000 Fax: (02) 6648 4199
Website: www.coffsharbour.nsw.gov.au ABN 79 126 214 487
This Application Form does not authorise use of the footpath. You must enter into a Licence with Council prior to using the footpath. A Licence will be forwarded to you for signature if your Application is successful. Refer to the ‘Coffs Harbour City Council Footway Activities Licensing Policy Guidelines relating to Merchandise, Merchandising Racks, Trading Tables & Associated Equipment’ for more information. PLEASE COMPLETE ALL SECTIONS.
1. Details of the shop
Shop Name
Address of Shop
2. Proposed licensee details
It is important that Council is able to contact you if more information is required. Please give as much detail as possible.
Mr Ms Mrs Other:
Given name/s or Company Name / Surname
ABN / Contact person
Guarantor’s full name (if Licensee is a Pty Ltd Company) / ABN
Licensee’s Postal address
Suburb or town / State / Postcode
Licensee’s Service Address (must be a place of residence or business – not a post office box)
Daytime telephone / Fax / Mobile
Email address
Solicitor’s Name, Postal Address & Phone (if applicable)
Name:
Address:
Phone:
Office Use Only
Date received / Application fee (if applicable) / Receipt No.
3. Proposed date of commencement of use of footpath Page 2
Commencement date:
4. Insurances
Certificate of Currency for Public Liability (minimum $20 million) is to be attached and submitted with this application to Council PRIOR to the use of the footpath. Coffs Harbour City Council MUST BE noted as an interested party on the Certificate of Currency.
5. Authorisation
If merchandise is to be in front of adjoining shops, a letter of permission from adjoining shop owner is to be attached.
6. Applicable fees and charges
Refer to Council’s adopted Fees & Charges – Outdoor Dining & Display of Goods on Council Footpaths. To view the applicable fees and charges associated with this application please refer to Council’s adopted fees and charges at www.coffsharbour.nsw.gov.au/fees
Application Fee attached / paid? (see page 14 of Guidelines) Yes No
All required documentation attached? Yes No
6. Privacy and personal information protection notice
· This information is voluntarily required to process your request and will not be used for any other purpose without seeking your consent, or as required by law;
· your information may comprise part of a public register related to this purpose;
· your application will be retained in Council’s Records Management System and disposed of in accordance with the Local Government Disposal Authority;
· your personal information can be accessed and corrected at any time by contacting this Council.
Applicant’s Signature/s
I declare that to the best of my knowledge all particulars supplied by me are correct and completed. I understand that inaccurate or false statements may cause my application to be delayed or rescinded.
Signature/s : …………………………………………………………………………… Date: ……/……./…….
Footway Activity Licence Application [FRM – E008] 2/12/2014