Business License Application - Health Club - City Of Auburn - Washington
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1FEES:
PLEASE RETURN TO:
Health Club
$85.00
Planning and Development
Renewal of Health Club
$20.00
25 West Main Street
Auburn, WA 98001
Business License Fee
$50.00
Phone: (253) 931-3090
Business License Renewal Fee
$50.00
Fax:
(253) 804-3114
HEALTH CLUB
APPLICATION FOR
INDIVIDUAL LICENSE
The Auburn Municipal Code requires that business activity which meet the criteria for individual licenses be applied for in
addition to a City of Auburn business registration from the City Clerk’s office. City of Auburn business registrations and
st
individual licenses are required to be renewed by December 31
of each year.
HEALTH CLUB OPERATOR BUSINESS INFORMATION:
Name:
Address:
City:
State:
Zip:
Telephone:
APPLICANT’S INFORMATION:
Name:
Address:
City:
State:
Zip:
Telephone:
Maiden Name:
Alias/Previous Name:
Drivers License No.:
Eye Color:
Hair Color:
Sex: M
F
HT:
WT:
Social Security No.:
Date of Birth:
Place of Birth:
U.S. Citizen: Yes
No
If no, please indicate status:
Previous Home Address Past (5) years:
1.
2.
Previous Employment Past (5) years:
1.
2.
STATE OF WASHINGTON
COUNTY OF KING
I, _______________________________________, being first duly sworn, on oath deposes and says: I am the above named applicant
and make this affidavit for the purpose of obtaining from the City of Auburn an HEALTH CLUB individual license. I have personal
knowledge of the matters stated in the individual license application, and the statements therein contained are true. I have read the
individual license regulation in Auburn City Code 8.24 and the legal requirements contained therein.
I, _______________________________________, hereby give permission to the City of Auburn to conduct an investigation into my
background. I waive any and all claims against any company, corporation or individual pertaining to information received from such
company, corporation or individual by the city as a result of such investigation.
___________________________________________
Signature of Applicant
Subscribed and sworn before me this _____date of___________________,
20___, Notary Public in and for the State of Washington, residing
at______________________. My Commission Expires:____/____/_____
:__________________________________________
Signature
FOR OFFICE USE ONLY:
Planning__________________
Date Received: ____________________
Building__________________
Amount Paid: _____________________
Fire______________________
TR Receipt #:______________________
Police____________________
Business License #:________________
Health Officer (Mailed Copy to King County) Date: ___________
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