Business License Renewal Form – Fill Out and Use This PDF

Name of Business (Name must be registered with the State of Utah)

DBA #

Business Phone

FAX

(

)

(

)

Business Address

Street:

City:

State:

Zip:

Mailing Address

Street:

City:

State:

Zip:

Type of Organization:

# of part time ____ and full time ____ employees?

Detailed Description of Business:

Proprietorship ( )

Corporation ( )

Partnership ( )

LLC ( )

Type of Chemicals Used:

Business Owner

Email Address:

Phone: (____)____________

Name:

Address:

City:

State:

Zip:

SSN# / Fed Tax #

State Sales Tax #

State License #

' Q $10.00 Application Processing Fee

' Q$75.00 Building Inspection Fee

PLEASE TAKE NOTICE that under Ordinance No. 2011-1014-O, all businesses

that receive a business license from Washington County must participate in the

This form is an application for a business license. The receipt for payment of

E-Verify program to verify the employment authorization of any newly hired

license fees thereof does not constitute being approved to operate a business.

employees. By submitting a signed application, the applicant certifies that (1) the

The actual license will be issued only when all inspections are completed and

business has used E-Verify to verify the employment authorization for all

signed off by the various County departments and the Business License

employees hired after December 17, 2011, and (2) the business will use E-Verify

Office gives approval. Washington County shall not be held responsible for

to verify the employment authorization of each newly hired employee no later

delays in processing an incomplete application, or for property improvements

than three days after the employee is hired. Additionally, an applicant is required

and other business expenditures occurring before the license applicant

to re-affirm its use of E-Verify annually on its business license renewal

receives final approval.

application.

Annual License Fees are as Follows:

1/We hereby agree to conduct said business strictly in accordance with the

' Q $50.00

Standard Business License

Laws and Ordinances covering such business, and swear under penalty of law

' Q$500.00

Beer License

A {a package}(CA, SA, AA)

that the information contained herein is true to the best of my knowledge.

' Q$500.00

Beer License

B {be consumed}(CA, SA, AA)

' Q $10.00

Ea. Full Time employee

X____________________________________________

' Q $ 5.00

Ea. Part Time employee

Signature

License Fee $______________

PLEASE NOTE: (72 hrs. required for processing)

(CA = County Commission Approval Required, SA = Sheriff Approval

Required, AA = County Attorney Approval Required)

1. Business Licenses expire annually on December 31.

If Applicable:

2. License renewal fees are due on or before January 31.

County Commission ________________________ Date: __________

3. A late fee of $10.00 after January 31.

' QCounty Attorney / County Sheriff Certificate attached if applicable.

OFFICE USE ONLY

BUSINESS LICENSE DEPARTMENT USE ONLY

Zone: _____________________________________ Home Office Only (

)

County License # ________________________ Clerk _____________

Home Occupation Permit:

Notes:

___________________________________________ Home Occupation (

)

Building Inspection: ______________________________ Date: __________

Building Officials Signature

Health Department: (Report)_______________________ Date: __________

Planner s Initials

Other Requirements:_____________________________________________

' QApproved by County Planner ____________________ Date: __________

DATE RECEIVED ___________________________________