City of Kenmore
6700 NE 181st Street
Kenmore, WA 98028
Phone (425) 398-8900
Fax (425) 481-3236

Business License Application

 

 

 

 

 

Office Use Only
Fee:
 $ Check Cash
Late Fee:
 $
Date Paid:
Receipt #:
License #:
Expiration:
Date Issued:
Type of Business
Check the appropriate boxes:
Adult Entertainment Massage Parlor/Bathhouse
Amusement Place Outdoor Musical Event*
Charitable Solicitation* Pawnbroker
Dance Secondhand Dealer
Live Entertainment Other (explain nature of business below):
*Requires Supplemental Information. See attached schedule for fees.

Name of Business:

DBA (Doing Business As) Name:

Business Address:
                                    Street                                                 City                                State             Zip

Mailing Address:
                                    Street                                                 City                                State             Zip

Contact Phone No.:                 Fax No.

E-mail Address:

Do you propose to serve liquor? Yes No

Property Information:

Do the applicant/owner/business control persons/partners Own, Rent, or Lease the premises? If the applicant/owner/business/control persons/partners do not own the premises, which individual(s) or entity(ies) own(s) the premises? Please provide name, address, telephone number of each owner and lessee of the business property:

First name: Middle: Last:

Address:
                                    Street                                                 City                                State             Zip

Telephone #:

First name: Middle: Last:

Address:
                                    Street                                                 City                                State             Zip

Telephone #:

First name: Middle: Last:

Address:
                                    Street                                                 City                                State             Zip

Telephone #:

Ownership Information:
Check One:
Individual Ownership Partnership
Sole Prorietorship Corporation/limited liability Partnership
Other  

If you are a partnership, please specify the type of partnership by checking one:

General Limited

Legal name of partnership: State Tax ID #: Federal ID #:

Name and address of any registered agent for service of process:

Name:

Address:
                                    Street                                                 City                                State             Zip

If you are a corporation limited liability company, please specify the following:

Legal name of corporation limited liability company:

State Tax ID #: Federal Tax ID#:

Date of incorporation: Place of Incorporation:

Name and address of any registered agent for service of process:

Name:

Address:
                                    Street                                                 City                                State             Zip

If you are a Sole Proprietorship or Individual ownership, please specify the following:

First name: Middle: Last:

State Tax ID #: Federal Tax ID#:

I certify that the foregoing is true and accurate.

 

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Applicant's Signature

Office Use Only
Date Entered: Signed off:
Partnership agreement (if applicable) _________ Police Department
Proof that business is qualified to do business in State of Washington _________ Fire Marshall
Legal description of property _________ Community Develp.
Diagram showing configuration _________ Code Compliance
Statement of total floor space