Form Fics7546a - Commercial Business Application - City Of Kent

City of Kent Commercial Business Ap pli ca tion

Ordinance No. 3035

Fee Must Accompany Application

Opening

City of Kent Customer Services

(Circle One)

July 1 or after

220 Fourth Avenue S.

New Business

$154.00

$104.00

Kent, WA 98032-5895

New Owner

$154.00

$104.00

Indep. Contractor

$100.00

$50.00

(253) 856-5210 Fax (253) 856-6200

Multiple Dwelling

$100.00

$50.00

(3 or more)

Non-Profi t

No Charge

501(c)(3)Req

PLEASE TYPE OR PRESS FIRMLY

Relocation in Kent

No Charge

Black or Dark Blue Ink Only

Prior Address: _______________________________

All licenses expire December 31. Renewal invoices mailed in December.

1. WA State UBI# ___________________ Name of Business ______________________________________________

2. NAICS __________________________ Address ___________________________________ Suite _____________

3. Date Opened in Kent ____/ ____/_____

Kent, WA Zip ______________________

Phone (

) _______________________

Fax (

) ________________

4. ! Indiv. ! Partnership ! LLC ! Corporation Provide ownership information; include supplemental list if needed.

Owner(s) Name(s)

Home Address

City

State

Zip

Phone

____________________

________________________

____________ _____ __________

(

)__________

____________________

________________________

____________ _____ __________

(

)__________

5. Contact Person: _________________________________________________________________________________

6. Name of Business Center/Apartment Complex, if Applicable _______________________________________________

7. Parent Company Name, if Applicable: ________________________________________________________________

8. Independent Contractor? ! Yes

! No

9. Billing Address: __________________________________________ City/State__________________ Zip _________

10. Description of Business: __________________________________________________________________________

11. Type of Business: (Check those which apply)

! Wholesale Trade

! Retail Trade

! Service

! Manufacturing

! Construction

! Govt.

! Transp./Commun./Util.

! Finance/Insur./RE

! Education

! Health Industry

! Sales/Mktg.

! Rental Housing # Units __________

! Other __________________________________________________

! No

! Yes

12. Do You Share a Location with Another Business?

Who? _______________________________

13. Include Work ing Owners—Total # Full Time Employees: ___________

Total # Part Time Employees: __________

__

14. Emergency Information for Fire & Police Departments: TWO after hours LOCAL names & phone numbers:

Name _____________________ Phone _____________ Name _____________________ Phone ______________

! Single-Tenant

! Multi-Tenant

! Single-Tenant Warehouse

15. Type of Building Occupied:

! Multi-Tenant Warehouse

! Mixed-Use-List mixed-uses:

16. Floor Space Occupied by Business in Square Feet________________________________________________________

17. Address(es) of Warehouse/Distribution Centers in Kent ____________________________________________________

18. Are there any hazardous materials used or stored at location ! Yes

! No

If Yes, explain ____________________________________________________________________________________

I hereby certify that the statements and information furnished by me on this application are true and complete to the best of my knowl edge.

I also acknowledge that the statements and information furnished by me on this application are public records and are available for public

inspection pursuant to State of Wash ing ton RCW 42.17.260. I un der stand that is su ance of this license is con di tioned upon compliance at all

times with all applicable ordinances, regulations and statutes of the City of Kent and the State of Washington. The is su ance of this business

license does not imply com pli ance with the Zoning, Uniform Fire and Build ing Codes.

19. ______________________________ _____________________________ _________________ ___________

Signature

Print Name

Title

Date

INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •

FOR OFFICE USE ONLY: Master Control # ____________________ Date Rec’d __________ Date Mailed ___________________________________

T.R. # ____________________ Amt. Paid _____________________ Other______________________________________________________________

fics7546A 12/06

White: BL File

Canary: Applicant’s Receipt Copy