Business/Contractors License
Application
2950 NW Vivion Road
Phone: 816-741-3993
Business Start Date ____/____/____
Legal Name of Business ______________________________________________________________________________________
Common Name of Business or DBA ____________________________________________________________________________
Nature of Business
__________________________________________________________________________________________________________________
Zoning of the Business _____________________________________ Will the Business have Outdoor Storage?
YES
NO
Business Address ______________________________________________ City ____________________ State ____ Zip _______
Mailing Address
______________________________________________ City ____________________ State ____ Zip _______
Local Phone (
) ____________________ Corp. Phone (
) _________________ Cell Phone (
) ____________________
E-Mail Address
____________________________________________________________________________________________
Primary Contact Name
_____________________________________ Home Phone (
) ___________________
(Owner/Corp. Agent)
Home Address ________________________________________________ City ____________________ State ____ Zip _______
Date of Birth ______________________ Drivers License Number __________________________
State Issued _____________
Secondary Business Contact Name ________________________________________________ Phone (
) ___________________
Please Complete this section if your business is physically located in Riverside.
Total number of persons employed at this location ____________________
Total Square Footage ____________________
Missouri State Sales Tax Number ____________________
Federal Identification Number ____________________
Is Business located in a Riverside residence? ____________________
Business previously located at this address: _____________________________________________________________________
Construction contractors must submit a current Workers’ Compensation Certificate pursuant to RSMo Chapter 287. (If exempt, sworn
affidavit must be signed and this may be done at City Hall.)
I declare under penalty of perjury that to the best of my knowledge and belief the statements made herein are true and correct.
_____________________
_______________________________________________
Signature of Owner(s) or Corporation Agent/Owner
Date
Notification is kindly requested if you discontinue business.
_______________________________________________
Title: Owner, Partner Manager or Corporate Officer
The applicant warrants the truthfulness of the information in this application. If incorrect information is provided, this license may be revoked. If license is issued wrongfully, whether based on misinformation or an
improper application of the code, this license may be revoked. The applicant agrees to abide by all Riverside Ordinances and State Laws and regulations.
Licensing Fees: Non-Industrial/Contractor-$48/ year
Heavy Industrial-$84/year
Business license fees for new businesses are prorated on a quarterly basis. Please contact City Hall for any questions
License Effective from ______________ To 12-31- ___________ Yearly Fee _____________ Approved by __________________
License Amount Remitted _________________ Type of Payment ______________ Business License Number _________________