Business License Application Form (Page 2 of 2) in pdf

Hospitals/Nursing & Retirement Homes: # beds _______

Refuse Haulers, Residential: # trucks ________

Salvage yards, inside: # sq. ft. _____________

Restaurants: # employees ___________

Motels: # rooms __________

Salvage yards, outside: # sq. ft. ____________

. Select Business License Category that best describes your business (check one that applies)

□

□ Manufacturing/Warehouse/Wholesale/Retail

Alcoholic Caterer

□

Alcoholic Distributor of Beer/Wine/Spirits

not otherwise listed herein

□

□ Motel/Hotel

Alcoholic Manufacturer

□

□ Nursery, Greenhouse, Tree-Trimmer

Automobile Body/Repair Shop

□

□ Office Space not otherwise listed herein

Automobile Wash

□

□ Pay Day / Title Loan

Bank, Credit Union, Finance Company

□

□ Personal Services (Beauty, Hair, Nails, Spa, Tanning)

CMB Retailer

□

□ Precious Metal Dealer / Pawnbroker

Collections Agent, Bail Bondsperson

□

□ Professional (Architect, Engineer, Physician, Dentist,

Contractor – Inside Lenexa

□

Contractor – Outside Lenexa

Accountant, RE/Ins Agent, Photographer, etc.)

□

□ Recreational Business – Indoor

Drinking Establishment

□

□ Recreational Business – Outdoor

Funeral Home

□

□ Refuse Hauler (check below which applies)

Gas Service Station

□

□ Residential

□ Commercial

Group Home

□

□ Restaurant

Hospital, Nursing Home, Retirement Home

□

□ School, for profit

Kennel – Commercial

□

□ Security Service Agency

Laundry & Dry Cleaning, including coin-op

□

□ Tow Service Provider

Liquor Store

□ Transportation – Bus/Taxi/Limo/Rental Car

□ Other: _____________________________

The City may convert to e-billing in the future. If so, there may be a processing fee to forward your

invoice via U.S. mail. Will you opt-in to the e-billing program?

□ Yes –

□ No

Business/Billing Email Address: __________________________________________

Lenexa locations: Who would be able to provide access to your building for City Emergency personnel?

Print names in order of preference to call first:

1. Name _____________________________ Tel # ________________

Alternate Tel # ________________

2. Name _____________________________ Tel # ________________

Alternate Tel # ________________

3. Name _____________________________ Tel # ________________

Alternate Tel # ________________

4. Name _____________________________ Tel # ________________

Alternate Tel # ________________

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

Title

Date

The filing of this application or the granting of a business license neither confirms nor approves the use of land as regulated under the provisions of the zoning code,

and is further subject to all applicable federal, state and local laws and regulations which apply to specific occupations and businesses. Whenever several business

classifications are applicable to a business, then said business, firm, or calling shall pay the highest classification herein.

□ Payment by Check – make check payable to City of Lenexa.

□ Payment by Credit Card – Please call City Hall at (913) 477-7500 to pay by credit card

FOR OFFICE USE ONLY

Business License No. __________________________ License Expiration Date _________________________

Yearly Fee _______________

□

CO necessary

Fee Remitted _________________

Cash / CC / Check # ______________

Receipt # ___________________

Rev. 2/25/15