Renewal Business License Application Form printable pdf download

BUSINESS LICENSE APPLICATION

City of Charleston

Approval Code: ___________________

915 Quarrier St., Suite 4

Staff Associate Initial: ______________

Charleston, WV 25301

Phone: (304)348-8024

License Fees: __________________

Penalty:

__________________

RENEWAL

TOTAL PAID:

______________

2016-2017

CITY OFFICIAL USE ONLY

ACCOUNT NUMBER

: _________________________

Name of Business: __________________________________

Please Note: This application is for the renewal of an existing

DBA: ______________________________________________

license. If you are a new business or new owner of an existing

business, you MUST complete the BUSINESS REGISTRATION

Attn: ______________________________________________

APPLICATION.

Mailing Address: ____________________________________

City:_________________State:__________Zip:____________

Section I. License Category:

General Business:

Liquor - Must attach valid WV ABCC License

____0. GENERAL BUSINESS ($20.00)

____6. Private Club Less than 1000 members ($500.00)

____7. Private Club More than 1000 members ($1,250.00)

Beer - Must attach valid WV ABCC License

____8. Fraternal, Veterans or Non -Profit Social Clubs ($375.00)

1. Distributor ($250.00)

Street Vending – Must provide Proof of Liability Insurance and

2. Dispenser ($100.00)

enter into

Hold Harmless Agreement with the City.

____3. Club ($100.00)

4. Class A Retail ($100.00)

____9. Street Vending ($20.00)

5. Class B Retail ($15.00)

Designated Street Vending Space:_____________________________________

(to be completed by City staff in consultation with applicant)

Section II. Business Information:

A. Name of Business: ____________________________________________________________________________________________________

DBA: ____________________________________________ Federal Employer ID/Social Security Number*:___________________________

Mailing Address: ______________________________________________________________ City:__________________________________

State: _________ Zip:________________ Phone Number: ____________________________________

Ownership Type: _____Sole Proprietorship _____Corporation _____Partnership _____Non-Profit

_____Other

***Please attach list of all officers, directors, proprietors or any individual owning 25% or more of the business.***

Name of individual preparing this application: _________________________________________________ Title: _______________________

D. Phone number of preparer: ___________________________________

Email: ________________________________________________

Description of your business: ____________________________________________________________________________________________

Does your business purchase gold, silver or other precious metals, jewels or products?

Yes / No

If yes, see City Code §18-863

Does your business sell?

Beer: Yes / No

Liquor: Yes / No

If Yes, you Must attach your ABCC license

H. Does your business sell or serve prepared food?

Yes / No

If Yes, you Must attach your Kanawha County Health Permit

Does your business conduct home solicitations or door-to-door sales?

Yes / No

If Yes, you Must post a $3,000 surety bond for

ales representative

each s

Do you own rental property that is located in Charleston?

Yes / No

If yes, How many rental units do you own? __________

Page 1 of 2

Revised 5/2017

Renewal Business License Application Form

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