Short Term Accomodation (STA) Licence Application
A. Property Information  (Property to be Licenced)
Building Number & Street Name
Unit Number
Postal Code
Ward Name
B. Owner Information  Applicant is:
*Last Name
*First Name
Corporation or Partnership (if applicable)
*Street Address
Unit number
Municipality
Postal Code
Province/State
*Primary Phone Number
Secondary Phone Number
*E-mail
C. Agent/Responsible Person (if different from owner)
Last Name
First Name
Corporation or Partnership (if applicable)
Street Address
Unit number
Municipality
Postal Code
Province/State
Primary Phone Number
Secondary Phone Number
E-Mail
F. Purpose of Application
Grandfathered STA Licence   New STA Licence   Licence Renewal - Previous Licence Number: Whole-home STA Owner/Tenant Occupied STA
G. Premises Details
No of Bedrooms/Guest Rooms Rented
No of Guest Suites Rented Separately Within the Whole Home
Maximum Number of Potential STA Occupants
Maximum Number of Occupants Over the Age of 10
Capacity of Septic Tank (Attach pump record/sewage system permit)
Do you currently or plan to serve breakfast, lunch or dinner? Yes No If yes, have you notified the Health Unit? Yes No
H. Attachments (to be emailed after submitting this form)
• A copy of the Transfer/Deed proving evidence of ownership
• For principal residence STAs, please fill in the attached Affidavit of Occupancy and provide proof thereof, such as a mailing address
• A site plan of the premises showing dimensions (see checklist for requirements)
• Floor plans showing dimensions of rooms
• Photograph of the front, back and sides of the STA home
• Proof of insurance, such as an insurance certificate from the Applicant's insurer, that:
     a. the Applicant has sufficient general liability insurance in the amount of no less than $2 million
     b. the Applicant's insurance policy contains coverage for damage from fire and does not prevent the applicant from using the subject property as a Short Term Accomodation, and
     c. the Applicant's insurance is cancellable by the Applicant's insurer on no more than 30 days prior notice
• Include attached information in accordance with the Complete Information Checklist for STA Licence Applications.
I. Declaration of Applicant (NOTE: If owner is not the applicant attach the "Authorization to Act as Agent" form)


The information contained in the application including attached schedules, plans and specifications, and other attached documentation is true to the best of my knowledge.  If the owner is a corporation or partnership, I have the authority to bind the corporation or partnership.

The Applicant acknowledges that County Officials may enter the property for the purposes of administering this application.
*Digital Signature Here: (use finger, stylus or mouse). Don't forget to also check [x] I'm not a robot.
 

 
Date

"Personal information contained in this form and schedules is collected under the authority of the Municipal Freedom of Information and Protection of Privacy Act and will be used for Short Term Accommodation information collection, as well as administration and enforcement of the Short Term Accommodation Licensing By-law. Questions about the collection of personal information may be addressed to the County of Prince Edward Clerk’s Office."