Application Date

Common Business Name (DBA)

Legal Business Name (if different from DBA)

Type of Business (Retail, Restaurant, Medical, etc.)

Check if Home Occupation Permission to release business

Physical Address

Federal ID & Sales Tax Number

Mailing Address (if different from Physical Address)

Business Phone Number

Business Fax Number

Business E-mail Address (For City Use – Public Notifications)

Days of Operation

Hours of Operation

Total Square Footage

# Full Time / Part Time Employees

BUSINESS CONTACT INFORMATION BUSINESS CONTACT INFORMATION (This information will be used by the Police Department to contact a responsible party in the event of an emergency)

Primary Contact Primary Contact

Owner/Operator Name (primary contact)

Phone Number

Address

Manager or Local Contact Manager or Local Contact

Name

Phone Number

Address

Other Business Contact Other Business Contact

Name

Phone Number

Address

BUSINESS CONTACT INFORMATION BUSINESS CONTACT INFORMATION (This information will be used by the Police Department to contact a responsible party in the event of an emergency)

Alarm Type Alarm Type None Burglar Hold-up

Burglar Alarm Type Burglar Alarm Type Audible Silent

Hold-up Alarm Type Hold-up Alarm Type Silent

Alarm Company Alarm Company

Alarm Company Name

Alarm Company Phone

After Hours Phone (Emergency)

Cleaning Service Cleaning Service

Cleaning Service Name

Cleaning Service Phone

After Hours Phone (Emergency)