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City of Burley 2020 Park Avenue P.O. Box 1090 Burley, Idaho 83318 Phone: (208)878-2538 Fax: (208)878-2539 ***Note: There will be a $25.00 application fee for all applications*** APPLICATION FOR COMMERCIAL BUSINESS LICENSE BUSINESS NAME: PHONE: BUSINESS LOCATION: (City, State, Zip Code) BUSINESS MAILING ADDRESS: (City, State, Zip Code) APPLICANT NAME: PHONE: EMAIL: PERMISSION TO CONTACT VIA EMAIL YES NO IF APPLICANT IS A PARTNERSHIP OR CORPORATION, LIST NAMES OF PARTERNERS OR OFFICERS NAME: ADDRESS: NAME: ADDRESS: NAME: ADDRESS: TYPE AND DESCRIPTION OF BUSINESS: Applicant Signature Date Note: When applicable- before a license will be issued, a copy of the Central District Health Department Certificate must accompany this application. Note: Issuance of a License is not intended as a determination that the applicant has met or complied with any or all of the applicant’s legal obligations or requirements of operating the applicant’s business. The issuance of a license shall in no way waive or reduce any legal obligation or responsibility of Licensee. Required Signatures of Approval Building Department (if applicable): Date Burley Rural Fire District: Date ***OFFICE USE ONLY*** Date Fee Paid: Receipt No.: APPROVED DENIED LICENSE NUMBER: City Clerk $25.00 SIGN