Acct. 4:

CARBON COUNTY: BUSINESS LICENSE APPLICATION

OUTSIDE THE LIMITS OF INCORPORATED CITIES AND TOWNS

 Date:________________________

TO THE BOARD OF CARBON COUNTY COMMISSIONERS:

The undersigned hereby requests that a Carbon County Business License be issued in the name of

the business shown below. Applicant agrees to comply with those sections of Carbon County

Ordinance NO. 281 which applies to the type of business activity indicated.

NAME OF APPLICANT:____________________________________ NAME OF BUSINESS:_____________________________________ TYPE OF BUSINESS:_________________________________________

BUSINESS ADDRESS:______________________________
                                        City_______________ ST______ Zip

MAILING ADDRESS:_______________________________
                City______________ ST______ Zip

PHONE: Business________________ Home___________________
                Other___________________ Fax_____________________

OWNER:_____________________________________

MANAGER:__________________________________

CONTACT PERSON:______________________________

Address if different from above:_______________________________________ City:_______________________ State:__________ Zip: STATE
 

SALES TAX NUMBER:______________________

FEDERAL TAX ID NUMBER:_____________________

EMAIL ADDRESS: ______________________________________________

ANY REQUIRED PERMIT AND/OR LICENSE
(contractor, day care, reg. permit, etc.)

CONTRACTOR LICENSES

Contractor License:_________________________________________

Occupation:___________________________________________

Class: ___________________________________________________________ Expiration:

DAY CARE - CHILD AND ADULT

St Day Care License:_____________________________________

Expiration:

ANIMAL RELATED BUSINESSES

Carbon County Animal Control Regulatory Permit:___________________

Expiration:

FOOD RELATED BUSINESSES

Food Handlers Permit:_____________________________

Expiration:

STATE LIQUOR LICENSE

State Liquor License:_________________________________

Expiration:

TRANSPORTATION BUSINESSES

Insurance Policy:

Expiration:

RECREATIONAL BUSINESS

Rodeos, Carnivals, Circus’, Etc.

Liability Insurance Policy:

Expiration:

AMBULANCE NEEDED: YES NO AUTH: ________________ DATE

MOTELS, HOTELS, MOBILE HOME PARKS

List total number of pads and/or rooms used and unused.

Motel Rooms:________________________

Hotel Rooms:_________________________

Mobile Home Park:___________________

RV Park:_______________________

NOTICE

To engage in the business for which this license is issued, you must comply with all county health and safety codes, including those relating to zoning, building, health, and fire safety. If now, or in the future, you do not comply with these codes, this license does not authorize you to engage in business.

CLERK’S OFFICE ONLY

Classification__________________________________________________

Part time_______ Full time_______ Amount of License____________

Paid: Check_________ Cash________

Doing Business From______________________ To________________________

PLANNING DEPT. ONLY

Approved as to proper zoning:

Premise Occupation:_______________ Home Occupation:

Zone:____________________ Fee:________________________ Special Conditions:__________________________________________________________
                    _____________________________________________    

 ________________________________Date___________________________

                    Zoning Administrator or Deputy

ANIMAL CONTROL DEPT. ONLY

Type of Business:____________________________________________

Regulatory Permit:_______________ Expiration:

Fee:______________________

Special Conditions:_________________________________________________
                    ________________________________________

               _________________________Date________________________
                    Animal Control Officer

I the undersigned applicant do swear that I/we will abide by all county health and safety codes, including County Ordinance 281.

x___________________ ____________________

Signature of Applicant(s)

 

We the undersigned, BOARD OF COUNTY COMMISSIONERS, Hereby certify that the above named may be issued a Business License.

_________________________Chair

_________________________Commissioner

_________________________Commissioner

 

Commission Meeting Date:__________________________________________