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Business Information (all fields required) NAME OF BUSINESS TRADE NAME / DBA (if different from Name of Business) BUSINESS LOCATION ADDRESS (No PO Box) CITY STATE ZIP+4 MAILING ADDRESS CHECK BOX IF ADDRESS IS THE SAME AS ABOVE CITY STATE ZIP+4 PLEASE ENTER DETAILED BUSINESS DESCRIPTION (SPECIFY ITEMS SOLD AND/OR SERVICES PERFORMED): DAYS & HOURS OF OPERATION: LIST HAZARDOUS MATERIALS STORED ON-SITE (NOTIFY PLEASE LIST A MANAGING AGENT RESPONSIBLE FOR THE LICENSEE’S COMPLIACE WITH TITLE 5 OF THE MONUMENT MUNICIPAL CODE (REQUIRED) FEIN OR EIN (Tax ID COLORADO SALES TAX NUMBER (or write “service industry” if applicable) TYPE OF BUSINESS (Check all that apply) Retail Communications Wholesale Medical Manufacturing Mail/Internet Order Service Leasing Construction Restaurant Home Occupation Office Only Ownership Information (all fields required) OWNER NAME OWNER PHONE OWNER OR BUSINESS EMAIL OWNER’S RESIDENTIAL ADDRESS CITY STATE ZIP+4 COMPLETE THE FOLLOWING FOR EACH OWNER, PARTNER, MEMBER, OR OFFICER NOT LISTED ABOVE: (Use additional sheet if necessary) NAME PHONE EMAIL RESIDENTIAL ADDRESS CITY STATE ZIP+4 EMERGENCY AFTER HOURS CONTACT(S): NAME/POSTION: PHONE: NAME/POSTION: PHONE: NAME/POSTION: PHONE: ALARM COMPANY AND PHONE NUMBER: TYPE OF OWNERSHIP (Check all that apply) INDIVIDUAL PARTNERSHIP LLP or LLLP LLC CORPORATION NON-PROFIT OTHER (LIST) Applicant Signature I, as the applicant, affirm under penalty of perjury, that I have read and understand the Business License Application; that I have not engaged in false or misleading advertising, falsified any business records, or participated in any unlawful business practices in a similar business; have not had a similar type business license revoked or suspended in this or any other locality in the twelve (12) months immediately preceding the date of the application; and the business, premises, building or land use complies with the requirements of the Town codes or entities having jurisdiction over activities conducted within the Town limit. I further affirm under penalty of perjury, that this application has been examined by me; that the statements made herein are made in good faith and, to the best of my knowledge and belief, are true, correct and complete; and that I am qualified under Federal or State law to engage in the activity authorized by the license. APPLICANT’S SIGNATURE PRINTED NAME DATE Check this box if you would like to receive emails with Town of Monument news and information. FOR TOWN USE ONLY Application For One of the Following: (check 1) New Business License ($75 Annual Fee) Renewal of Existing Business License ($75 Annual Fee) Non-profit Organization (Proof of Non-profit Status Required) Address Change for Existing License (No Fee) Supplemental Documents: (check if applicable) Business Premise Form (Required if physically located in Town) Home Occupation Agreement (Required for all home occupations) Temporary Use Permit (Required for Mobile Vendors) DATE: LICENSE No. Fee received: CHECK CREDIT CARD CASH RECEIVED BY ZONING DATE APPROVED: Town of Monument Business License Application 645 Beacon Lite Rd., Monument CO 80132 [PHONE REDACTED] www.townofmonument.org ---PAGE BREAK--- BUSINESS PREMISE FORM (**PLEASE PRINT CLEARLY AND LEGIBLY) Please return completed form - Attention: Communications Center by : email [EMAIL REDACTED]; fax (719) 391-8917; or mail to: 27 E. Vermijo Ave., Colorado Springs, CO 80903 Date: Business Business Business Days & Hours of operation: Alarm Company & Phone Hazardous materials: Y / N (**If YES please notify your local fire department with the details.) AFTER HOURS CONTACTS 1. Name/position: Home Cell 2. Name/position: Home Cell 3. Name/position: Home Cell **PLEASE KEEP US INFORMED OF ANY CHANGES TO THE ABOVE INFORMATION SO THAT WE CAN BETTER SERVE YOU. THANK YOU ---PAGE BREAK--- Street Address (No PO Box): Business Name: Business Operator: Email: Phone: Nature of Business: (attach separate sheet if needed) Will Hazardous Materials be stored at this location? YES NO Stored Materials Storage Location: A home occupation is a business, profession, occupation or trade conducted entirely within a residential principal or accessory building, which use is accessory, incidental and secondary to the use of the building for dwelling purposes and does not change the essential residential character or appearance of such building or the neighborhood and is compatible with other permitted uses. (Please acknowledge that you have reviewed the below by placing a check mark in each box) □ I have read 17.48.200 Accessory uses; home occupation of the Town of Monument Municipal Code. □ I understand that the following uses are not considered home occupations: motor vehicle repair and motor vehicle body shops; medical or dental clinics; hospitals; personal services such as beauty and barber shops, tattoo, and massage services; bed and breakfast establishments; animal clinics, hospitals, or grooming establishments; or retail businesses or any similar uses generating more than occasional or minimal vehicular traffic. □ I understand that the Town of Monument has the right of an annual inspection to determine compliance with the applicable home occupation criteria, any conditions of approval, and all applicable municipal, state and federal regulations. □ I understand that in the event of a conflict between the provisions of the Town of Monument’s Municipal Code, Chapter 17.48.200, and applicable covenants, conditions and restrictions of record applicable to the above property, the more restrictive provision(s) shall govern and control. □ I understand and agree that I will apply for and obtain a Business License from the Town of Monument before commencing a home business. By my signature below, and the boxes checked above, I certify that I have read, understand and will comply with the Town’s zoning regulations. Printed Name of Business Owner: Signed Date Return to: Tina Erickson Business License Manager Phone: (719) 884-8047 645 Beacon Lite Rd [EMAIL REDACTED] Monument, Colorado 80132 HOME OCCUPATION AGREEMENT