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OpenNorfolk Request Form
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Name of Restaurant
*
Address of Restaurant
*
Address Continued
City
*
State
*
Zip
*
Name of Contact
First Name
*
Last Name
*
Phone Number
*
Email Address
*
Do you have a parking lot for your restaurant?
*
-- Select One --
Yes
No
Do you need to place outdoor dining on the sidewalk or in nearby on street parking?
*
-- Select One --
Yes
No
Do you have adequate lighting for outdoor dining in the evening?
*
-- Select One --
Yes
No
Do you have an ABC license?
*
-- Select One --
Yes
No
Do you have tables and chairs that can be used for outdoor dining?
*
-- Select One --
Yes
No
Do you need outdoor heaters?
*
-- Select One --
Yes
No
What kind?
-- Select One --
Freestanding
Hanging
Wall-Mounted
Do you have a 15 Amp circuit that can be dedicated to each heater, or room on your electrical panel to add dedicated circuits for heaters?
-- Select One --
Yes
No
Please provide any additional comments or concerns you may have:
Are you a women-owned business?
*
-- Select One --
Yes
No
Are you a minority-owned business?
*
-- Select One --
Yes
No
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