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Page 1 of 2 Thomas B. Quaw Square ▪ 91 E. Central ▪ Belgrade, MT 59714 ▪ Phone: (406) 388-3560 ▪ Email: [EMAIL REDACTED] July 28, 2023 Dear Applicant: Marijuana businesses within the City of Belgrade Zoning Jurisdiction is regulated pursuant to state law, City of Belgrade Zoning Ordinance §10.3.20 and the Belgrade City Code. All applicable building and fire codes/inspections also apply to these businesses. Submittal requirements for marijuana business licenses include a completed application form, a City of Belgrade Business License Application (the application fee for this item will be waived), copies of all related state licenses including the date of expiration, and verification that the location of the marijuana business complies with state and local regulations. The verification statement that the location of the marijuana business complies with state and local regulations must include at a minimum the following information: • The proposed location is not located within a residential zoning district or the Educational and Institutional (EI) district. • The proposed location is not located within a building containing residential units or a building that contains a hotel, motel, or any room for overnight lodging at the time of establishment of the business. • The proposed location is not located within 500 feet of lots used for public or quasi- public buildings or churches as defined in City of Belgrade Zoning Ordinance §10.8.3. • The proposed location is not located within 500 feet of any residence, in any direction, located in R, N, RS, MR, and CL districts. • The proposed location is not located within 500 feet, in any direction, of Lewis and Clark Park. • The proposed location is in compliance with all separation requirements of MCA §16-12-207 City staff will do a cursory review to ensure compliance, but the applicant is responsible for verification that the location complies with state law. Please note that, in some cases, additional information may be required before a license may be issued. All City of Belgrade Marijuana Business Licenses must be renewed annually and are non-transferable. The cost of an annual marijuana business license is $100.00. City of Belgrade Community Development Department ---PAGE BREAK--- Page 2 of 2 Thomas B. Quaw Square ▪ 91 E. Central ▪ Belgrade, MT 59714 ▪ Phone: (406) 388-3560 ▪ Email: [EMAIL REDACTED] OFFICE USE ONLY: Zoning Final Approval Date Approved By CITY OF BELGRADE MARIJUANA BUSINESS LICENSE APPLICATION $100.00 Fee to the City of Belgrade Business Name Physical Address Mailing Address Business Phone Email Address Type of Marijuana Business (Check All That Apply): Dispensary Manufacturer Transporter Cultivator Tester Business Owner Full Legal Name Phone Email Co-Owner Manager (Check One) Full Legal Name Phone Email Location Verification Statement:  The proposed location is not located within a residential zoning district or the Educational and Institutional (EI) district.  The proposed location is not located within a building containing residential units or a building that contains a hotel, motel, or any room for overnight lodging at the time of establishment of the business.  The proposed location is not located within 500 feet of lots used for public or quasi- public buildings or churches as defined in City of Belgrade Zoning Ordinance §10.8.3.  The proposed location is not located within 500 feet of any residence, in any direction, located in R, N, RS, MR, and CL districts.  The proposed location is not located within 500 feet, in any direction, of Lewis and Clark Park.  The proposed location is in compliance with all separation requirements of MCA §16-12-207 In addition to this form, please submit this application with the following materials: A City of Belgrade Business License Application (the application fee for this item will be waived), a Copy of all applicable state licenses issued by Dept. of Revenue for activities occurring at location listed above, including marijuana worker permits for individuals listed on this application, and written permission of the property owner (if different than the business owner) to conduct a marijuana business on the premises. This application is made subject to the terms of the Belgrade City Code. I understand that this license is NOT TRANSFERABLE and MUST BE RENEWED ANNUALLY. Further, I declare under penalty of Perjury or False Swearing that the information I have supplied is correct to the best of my knowledge. Signature Date Business License # (OFFICE USE ONLY)