Section 1 of 1 in this document

Daycare Renewal Application

Daycares are required to submit this form to the Planning and Development Services Department every two years for approval. An annual inspection by the Fire Department is also required.

Business Information

Business name

Business phone

Does the applicant live at this address?

Yes

Does anyone live at this address?

Yes

Hours of operation (open to close)

Number of children proposed to be cared for

Number of children authorized to be cared for by the State

How many children are ages 0-5?

How many employees occupy the building during the peak shift?

For the next question, you can open the City of Pocatello Zoning Map or leave the answer blank, and we will find the zone for you.

What zone are you located in?

How long has your business been in this location?

If less than 5 years, what was the business that previously occupied this address?

Does your business have a Conditional Use Permit for this use?

Yes

Attachments

Please attach a graphic of your parking lot.

Click Here to Upload

Please attach a floor plan of your building.

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Please attach any other applicable document.

Click Here to Upload

Applicant

Signature

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

Daycare Renewal Application

Business Information

Business address

Does the applicant live at this address?

Does anyone live at this address?

Name of licensed childcare provider

Does your business have a Conditional Use Permit for this use?

Attachments

Please attach a graphic of your parking lot.

Please attach a floor plan of your building.

Please attach any other applicable document.

Applicant

Signature