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

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Yes No

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

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 *

Fire Alarm *

$100

Address *

Video Games