Form Fics7546b - Home Business License Application - City Of Kent

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City of Kent Home Business License Ap pli ca tion
Ordinance No. 3035
City of Kent Customer Services
Fee Must Accompany Application
Opening
220 Fourth Avenue S.
(Circle One)
July 1 or after
Kent, WA 98032-5895
Home Occupation
$25.00
$12.50
(253) 856-5210 Fax (253) 856-6200
Non-Profit
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.
Name of Business __________________________________________
1. WA State UBI# ___________________
Address ________________________________________ Suite ____
2. NAICS _________________________
Phone (
) _____________________
Fax (
) ________________
3. Date Opened in Kent _____/_____/_____
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. 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
11. Do You Share a Location with Another Business?
Whom? _____________________________
12. Include Work ing Owners—Total # Full Time Employees: ___________
Total # Part Time Employees: _________
13. Address(es) of Warehouse/Distribution Centers in Kent ___________________________________________________
14. Explain your home business. Specify if your business is a service or produces a product. ________________________
_______________________________________________________________________________________________
15. Have you read and do you understand Section 15.08.040 of the Kent Zoning Code? ! Yes
! No
16. Operation of your business: Days of Week:_______________________________
Hours of the Day: _____________
17. Will changes to the interior or exterior of your dwelling be needed to accommodate the business?
! Yes
! No
If yes, explain_____________________________________________________________________
_______________________________________________________________________________________________
18. Will there be any outside storage of goods or display of materials or merchandise? ! Yes
! No
If yes, explain____________________________________________________________________________________
19. Will there be any hazardous materials stored or used ! Yes
! No
If yes, explain____________________________________________________________________________________
20. What is the total number of square feet of your home your business will occupy? ______________________________
21. How many visits per week will there be to your home by clients, employees or delivery services? ___________ visits
22. Will there be noticeable changes to your present utility usage as a result of your home occupation? ! Yes
! No
If yes, explain___________________________________________________________________________________
______________________________________________________________________________________________
22. Will there be noticeable changes to your environment, such as noise, vibration, smoke, dust, heat or glare as a result of
your home business? ! 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.
24. ______________________________ _____________________________ _________________ ___________
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:_____________________________________
fics7546B 11/05
White: BL File
Canary: Applicant’s Receipt Copy

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