Annual Privilege License Approval Application Form - City Of Huntsville

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CITY OF HUNTSVILLE
ANNUAL PRIVILEGE LICENSE APPROVAL APPLICATION
____________________________________________________________________________________
FOR OFFICE USE ONLY
TAXPAYER ID # _____________________
LOC # _____________
LICENSE INSPECTOR OR CLERK _______________________
_____ NEW
_____ TRANSFER
_____LOCATION CHANGE
_____ ADDITIONAL SCHEDULE NO.
______________________________________________________________________________________________________________________________
TO WHOM IT MAY CONCERN:
I AM APPLYING FOR A CITY OF HUNTSVILLE PRIVILEGE LICENSE ACCORDING TO ORDINANCE 93-725.
TAXPAYER NAME (OWNING ENTITY) _________________________________________________________________
LOCATION TRADE NAME (DBA) ______________________________________________________________________
LOCATION ADDRESS IN HUNTSVILLE ________________________________________________________________
________________________________________________________________
BELOW IS A DESCRIPTION OF BUSINESS TO BE CONDUCTED AT THE LOCATION LISTED ABOVE.
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Person to be contacted if any questions arise concerning this application during the approval process.
___________________________________________________
(________) ________________________________
NAME (please print or type)
DAYTIME TELEPHONE NUMBER
___________________________________________________
__________________________________________
SIGNATURE
DATE
DISPOSITION
DEPARTMENT
RECOMMENDATION
SIGNATURE OF DIR. OR
DATE
APPROVAL/DISAPPROVAL
AUTHORIZED
REPRESENTATIVE
1. Inspection Dept. 427-5331
__________________________
__________________________
________________
2. Health Dept.
539-3711
__________________________
__________________________
_______________
3. Fire Dept.
427-5144
__________________________
__________________________
________________
4. Finance Dept.
427-5070
__________________________
__________________________
________________
NOTE: Department memorandum should be attached to application for disapproval recommendations and other cases,
where needed for clarification after notifying the above named person (if possible) of the circumstances involved
.
****************************************************************************************************
REMARKS/COMMENTS
FORM DATED 1/2/2002

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