Application For Business License - City Of Mercer Island
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1
2CITY OF MERCER ISLAND
APPLICATION FOR BUSINESS LICENSE
RETURN COMPLETED APPLICATION and
ENCLOSE $30.00 LICENSE FEE CHECK MADE
PAYABLE TO:
Receipt #
_______________________
Application Date _______________________
CITY OF MERCER ISLAND
TH
9611 SE 36
ST
Issuance Date
_______________________
MERCER ISLAND WA 98040-3732
License Number
_______________________
For additional information call: (206) 275-7783
**WASHINGTON STATE DEPARTMENT OF REVENUE REGISTRATION (UBI) # ________________________________
BUSINESS NAME ___________________________________________________________________________________________
MAILING ADDRESS _________________________________________________________________________________________
CITY ____________________________________STATE _________ZIP ____________ PHONE (
)___________________
ADDRESS OF PHYSICAL LOCATION OF BUSINESS IF OTHER THAN ABOVE ______________________________________
________________________________________________________________________
PHONE (
)___________________
NATURE OF BUSINESS ____________________________________________________ No. of Employees__________________
BUSINESS CLASSIFICATION:
HOME OCCUPATION (business conducted within a home).
Resident Commercial Business (business conducted from place of business located in the non-residential zone of
Mercer Island). Square footage of business _________________.
Non-Resident Commercial Business (business conducted from place of business located outside of Mercer Island).
Temporary Business (business conducted for period of less than one month).
Master Exhibitor’s License (available for sponsors of carnivals, exhibitions or like events not extending more than 7
days).
OWNERSHIP IS:
Sole Proprietorship
Partnership
Corporation
LLC
PRINCIPAL(S) ______________________________________________________________________________________________
The undersigned hereby applies for a business license in accordance with the foregoing information, under and pursuant to Mercer
Island City Code section 5.01, and hereby certifies the information contained herein as true and correct to the best of the applicant’s
knowledge and belief.
SIGNATURE OF APPLICANT _________________________________________________________________
NAME (Please Print) _________________________________________________ Date ____________________________________
NOTE: Contractors please complete and sign the reverse side
S:\DSG\CST\Forms_All_DSG\FORM2000\Miscellaneous\M1002 - BUS LICENSE.W.doc
6/08
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