Application For Original Establishment License Form - Idaho Bureau Of Occupational Licenses
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1STATE OF IDAHO
BUREAU OF OCCUPATIONAL LICENSES
OWYHEE PLAZA
1109 MAIN STREET, SUITE 220
BOISE, IDAHO 83702-5642
APPLICATION FOR ORIGINAL ESTABLISHMENT LICENSE
________________________________________________________________________________________
Name of Establishment ______________________________________________________________________________________
Shop Location Address ______________________________________________________________________________________
street
city
state
zip
Shop Mailing Address________________________________________________________________________________________
street
city
state
zip
Shop Phone Number _______________________
Home Phone Number __________________
Name of Shop Owner(s) ______________________________________________________________________________________
I hereby make application for a [ ] Barber Shop ($50.00 fee enclosed) license that will expire on either June 30 of the year in which
it is issued, or a [ ] Cosmetology Shop ($50.00 fee enclosed) license that will expire on December 31. Licenses are not be prorated
for partial years.
Anticipated opening date_____________________
(The appropriate shop license must be in your possession & conspicuously posted in the shop before offering services.)
Has any Barber or Cosmetology establishment previously existed at this location?
[ ] YES
[ ] NO
If YES, give business name _______________________________________________, establishment license # _______________,
and owner's name____________________________________________________________________________________________.
If YES & the license is current, that license (marked "out of business" & signed by the previous owner), or a written statement from
the previous owner surrendering ownership, must be submitted with this application,
Does this application represent a change in location of your establishment?
[ ] YES
[ ] NO
If YES, give business name _______________________________________________, establishment license # _______________,
and former establishment address________________________________________________________________________________.
I hereby certify that the above named establishment meets the licensure requirements as outlined by Idaho Laws & Rules including: a
working floor space of not less than 108 square feet for a single station shop & an additional 50 square feet for each additional station;
toilet facilities, including sink with hot & cold running water, conveniently located & accessible from within the building where the
establishment is located; hot & cold running water & approved drainage system separate from the toilet facilities.
I further certify that I am familiar with the city/county planning & zoning regulations affecting the establishment listed above and that
I assume all responsibility for their compliance.
I further certify that I authorize the continued operation of all contiguous establishments that may be currently licensed at this location.
I further certify that the information recorded hereon is correct to the best of my knowledge and belief.
__________________________________________________
Signature of owner(s) or authorized agent(s)
State of ______________, County of _________________________, ss.
Subscribed and sworn before me this ______ day of _______________________, 20 _____.
(seal)
__________________________________________________
Notary Public official signature
residing at _________________________________________
my commission expires_______________________________
(SEE THE REVERSE SIDE FOR DIAGRAM INSTRUCTIONS)
BOL-OE1-06/00
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Parent category: Business