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APPLICATION FOR PLUMBING BUSINESS LICENSE 2023 BUSINESS NAME AND MAILING ADDRESS: NAME OF APPLICANT AND TITLE: PHYSICAL ADDRESS IF DIFFERENT FROM ABOVE: BUSINESS PHONE: HOME PHONE: EMAIL ADDRESS: DESCRIPTION - EXACT NATURE OF BUSINESS: OPERATING HOURS: NO. OF EMPLOYEES: ANTICIPATED IMPACT ON TRAFFIC FLOW: TYPE OF SIGNS OR LIGHTS TO BE USED AT BUSINESS LOCATION: CONTRACTOR’S or STATE LICENSE: LIABILITY INSURANCE COMPANY: BUSINESS REFERENCES AND PHONE NUMBERS: 1. PHONE: 2. PHONE: EMERGENCY CALL OUT INFORMATION: 1. 2. ADDITIONAL INFORMATION: (ie-where is equipment stored) ATTACHED HERETO IS MY NON-REFUNDABLE PAYMENT IN THE AMOUNT OF $100.00 FOR A BUSINESS LICENSE FEE. THIS APPLICATION FOR MY BUSINESS LICENSE IS MADE SUBJECT TO ALL THE TERMS AND CONDITIONS OF TITLE 2, BELGRADE CITY CODE AND AMENDMENTS OF THE CITY OF BELGRADE. THIS LICENSE IS NOT TRANSFERABLE. ALL LICENSES EXPIRE ON DECEMBER 31 OF EACH YEAR. ALL LICENSES SHALL BE PAYABLE YEARLY ON OR BEFORE JANUARY 1ST OF EACH CALENDAR YEAR. PLEASE RETURN ENTIRE APPLICATION SIGNED AND DATED. SIGNATURE OF APPLICANT DATE For Office Use Only: Police Zone Off. City Mgr Rec # Date PD Lic Date Issued