Application For Business License - City Of Mercer Island (Page 2 of 2) in pdf

________________________________________________________________________

Washington State Contractors License Number

Effective Date _____________________________________ Expiration Date ____________________________________________

AFFIDAVIT OF ELIGIBILITY FOR BUSINESS LICENSE

I/We, the undersigned, have read and understand the provisions of MICC section 5.01.130 below. I/We, the undersigned, do hereby

certify that the provisions of MICC section 5.01.130 do not apply to myself or any of my servants, agents or employees. I/We, the

undersigned, do hereby certify that it is understood that if the provisions of MICC section 5.10.130 do apply, the business license may

be denied, suspended or revoked. I/We, the undersigned, do hereby certify, under penalty of perjury, that the information furnished

herein and in connection with the application for a business license is true and correct to the best of my knowledge, information and

belief.

SIGNATURE OF APPLICANT _____________________________________________________DATE_______________________

MERCER ISLAND CITY CODE Section 5.01.130 – Denial, suspension or revocation of licenses.

Revocation by City Clerk. The City Clerk shall have the right to revoke and suspend any license at any time on the

following grounds:

1. That the license was procured by fraud or false representation of facts;

2. That the applicant or licensee or any of his servants, agents or employees, while acting within the scope of their

employment, has violated or failed to comply with any of the ordinances of the city; provided that this section of said

violations are corrected within a period of thirty (30) days from the date of the violation or when said violations are

deemed not significant by the City Clerk; or said violations are deemed not significant by the City Clerk; or

That the licensee or any of his servants, agents or employees has been convicted of either a felony or misdemeanor

involving moral turpitude,

or involving fraud or an attempt or defraud while acting within the scope of their employment;

4. Conviction of a violation of any provision of this title shall be prima facie evidence to warrant suspension or revocation

of the license.

The City Clerk, upon finding that one or more of the above cited conditions exist, shall suspend the business license for a period of

thirty (30) days in case of a first violation and revoke the business license in cases involving a second violation.

FOR CITY USE ONLY

DEVELOPMENT SERVICES AND PUBLIC SAFETY REVIEW

1. ZONING ______________________________________

9. COMMENTS____________________________________

2. PARKING______________________________________

__________________________________________________

3. SIGNS_________________________________________

__________________________________________________

4. TYPE OF CONSTRUCTION_______________________

__________________________________________________

5. OCCUPANCY GROUP___________________________

__________________________________________________

6. AREA (Sq. ft.)___________________________________

10. Following information sent:

7. NUMBER OF STORIES___________________________

a. Home occupation information____________________

8. OCCUPANT LOAD______________________________

b. Other _______________________________________

FINAL APPROVAL

FIRE MARSHAL ____________________________________

Date ______________________________________________

CODE OFFICIAL ____________________________________

Date ______________________________________________

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Application For Business License - City Of Mercer Island Page 2

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