Application For Contiguous Establishment License Form printable pdf download

STATE OF IDAHO

BUREAU OF OCCUPATIONAL LICENSES

1109 Main St., Suite 220

Boise, Idaho 83702-5642

(208) 334-3233

e-mail

dfoss@ibol.state.id.us

APPLICATION FOR CONTIGUOUS ESTABLISHMENT LICENSE

__________________________________________________________________________________________

Name of Contiguous Establishment_____________________________________________________________________________

Shop Location Address_______________________________________________________________________________________

street

city

state

zip

Shop Mailing Address________________________________________________________________________________________

street

city

state

zip

Shop Phone Number _______________________

Home Phone Number __________________

Name of Contiguous 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 – see NOTE on page 2) 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 this area been previously licensed as a Contiguous establishment?

[ ] 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 50 square feet for each station; a minimum three (3) foot wide access into the contiguous shop

area; access to toilet facilities, including sink with hot & cold running water, conveniently located & accessible from within the

building where the establishment is located; and access to hot & cold running water & approved drainage system separate from the

toilet facilities.

I further certify that the information recorded hereon is correct to the best of my knowledge and belief.

I further certify that I agree to assume all responsibility for the ownership and current licensure of this Contiguous establishment.

__________________________________________________

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_______________________________

(page 1 of 2)

Application For Contiguous Establishment License Form

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