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Renewal
New
Change of Owner
Food - Restaurant
Food - Market Food Vending Machine
Junk Yard
Pet Shop
Private Business
Professional Office
Retail
Salon
Other
Change of Owner
Caterer
Deli
Luncheonette
Outdoor Cafe
Restaurant with Bar
Bakery
Fish
Grocery
Meat
Produce
Super Market
Yes
No
Yes
No
Yes
No
Yes
No
AL
AK
AZ
AR
CA
CO
CT
DE
FL
HI
ID
IL
IA
KS
KY
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
AS
DC
FM
GU
MH
MP
PW
PR
VI
Yes
No
Type Full Name :
Sign With Hand
Clear
Done
Last Name
*
Phone #
*
Name
Professional Office
Address
Email
*
Block
ATMs
*
Health
Proof of Business Liability Insurance must be attached in order to process your application.
Business Details
Registration Type
*
$15
If Yes, how many?
Address
*
Restaurant Type (If Applicable)
Address 2
$75
Vending Machines
*
Mailing City, State, ZIP
Food Market Type (If Applicable)
Address
If Yes, how many?
Tourism
Burglar Alarm
*
If Yes, how many?
Phone #
*
Do you provide outdoor dining?
Video Games
*
Business Name
*
$40
$75
Name
*
Business Category (If Other)
$50
$100
Lot
Address
Emergency Contact Details
Building Owner Details
State
*
Food Businesses Only:
Federal ID #
*
Phone #
*
Fee Schedule
Total Fee Due
Last Name
*
Waste Management Company
Phone #
Business Category
*
First Name
*
Date and Times of Pickup
Audible
*
License
Phone #
$100
Address
Certification
Attachments
$100
{[CNAME]}
{[ADDR]}
{[CITY]}, {[STATE]} {[ZIP]}
{[APHONE]}
{[AWEBSITE]}
Applicant Signature
*
Business Owner Details
Food Establishment Only:
ATM Machine
Description
*
First Name
*
City
*
Alarm Company Details
Central Station
*
Outdoor Dining Permit
Knock Box
*
Square Feet
Fire
Vending Machine
Email
ZIP
*
{[PNAME]}
Fire Alarm
*
$100
Address
*
Video Games
Your application has been submitted successfully.
Reference Number:
Date Submitted:
Business Name:
Fee:
Confirmation email sent to: