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Page 1 of 3 Rev. 3.17.25 833 S. Spruce St. Burlington, WA 98233 Phone: (360) 755-0531 Fax: (360) 755-9565 PEDDLER’S LICENSE APPLICATION New Renewal FEE: Application $50.00/ per person (Non-refundable Background Check Fee) Peddler’s License - $10.00 per person/ per day DATE: Business Location Street City State Zip Mailing Address City State Zip Nature of Business/Items Sold Method of Sales Door-to-door) Date of Sale List Owner(s), partners, Officers* (use back of application, if necessary) Title Home Address Home Phone *Use Page 3 to list employees Name of Applicant Date of Birth Social Security # Drivers License # Height Weight Eyes Hair Vehicle License (if used in business) List any and all criminal history: Washington State UBI # I hereby certify that the statements furnished by me on this application are true and complete to the best of my knowledge and belief, and that I will comply with the provisions of all City of Burlington ordinances connected with doing business in Burlington. Date Signature Title ---PAGE BREAK--- Page 2 of 3 Rev. 3.17.25 833 S. Spruce St. Burlington, WA 98233 Phone: (360) 755-0531 Fax: (360) 755-9565 Burlington Municipal Code 5.16.050.8 Names of at least two property owners in Skagit County, Washington, who will certify as to the applicant’s good character and business responsibility. Name Address Name Address Burlington Municipal Code 5.16.050.10 The last three cities where the applicant did business immediately preceding the date of this application and the addresses from which such business was conducted in those municipalities: 1) Business Address 2) Phone Business Address Phone 3) Business Address Phone ---PAGE BREAK--- Page 3 of 3 Rev. 3.17.25 833 S. Spruce St. Burlington, WA 98233 Phone: (360) 755-0531 Fax: (360) 755-9565 EMPLOYEES OF DOOR-TO-DOOR SALES Please Submit a Copy of Each Employee’s ID Name of Business EMPLOYEE’S FULL NAME (First, Middle, Last) Please Print DATE OF BIRTH