Form Txl 184 - Application For Certificate Of Registration And Licensing - City Of Taxoma, Washington
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1
2
3City of Tacoma
Sent By______________ Date______________
Finance Department/Tax & License Division
733 Market Street, Room 21, Tacoma, WA 98402-3770
(253) 591-5252 •
Contract Account _______________________
APPLICATION FOR CERTIFICATE OF REGISTRATION AND LICENSING
Title 6 of the Tacoma Municipal Code, as amended.
Yes
❐
No
❐
Have you ever been registered as a business with the City of Tacoma? If yes, what is the Name and Address of your previous business
Name ______________________________________ Address _____________________________________________________________________
Yes
No
Purchasing an existing business? If yes, what is the Name, Address & Phone Number of previous owner.
❐
❐
Name _______________________________________ Address ____________________________________ Phone _________________________
Yes
No
Are you currently a Tacoma Public Utilities Customer? If yes, enter your account # ____________________________________________
❐
❐
and complete Commercial and Industrial Surveys on the next page.
Have you contacted the City's Building and Land Use Services to ensure your business location and activity meet the
Yes
❐
No
❐
City's Zoning requirements? If no, please call (253) 591-5577
Yes
❐
No
❐
Have you contacted the City of Tacoma's Fire Department to ensure your business location and activity meet the City's
Fire requirements? If no, please call (253) 591-5740
**CITY ZONING AND FIRE REQUIREMENTS MUST BE MET BEFORE BUSINESS ACTIVITY COMMENCES IN THE CITY OF TACOMA**
Sole owner ❐ Date of birth ______-____-_______
Full legal name of owner ______________________________________________________________________________ SSN ____________________
Full legal name of spouse _____________________________________________________________________________ SSN ____________________
Home address __________________________________________________________City ___________ State ________ Zip ___________________
Phone (______) ______ - ________ Work Phone (______) ______ - ________ E-mail Address __________________________________________
(Please complete Section A)
LLC ❐ Partnership ❐ Corporation ❐
Name of LLC, partnership, or corporation _______________________________________________________________________________________
Business Phone (______) ______ - ________ Business Fax # (______) ______ - ________ Cellular Phone # (______) ______ - ________
E-Mail Address _________________________________________________________
Physical location _____________________________________________________________ City__________________ State _____ Zip_________
(# & street — DO NOT use PO Box or Mail Drop)
Mailing Address _____________________________________________________________ City__________________ State _____ Zip_________
State UBI # ___________________ Federal EI # ______________________________ State Professional License _____________________
SECTION A
Name ________________________________________________ Title __________________________________________________________________
Home address ___________________________________________________ City ________________________ State ______ Zip_________________
Social Security #______-____-_______ Home phone _______________________
Name ________________________________________________ Title __________________________________________________________________
Home address ___________________________________________________ City ________________________ State ______ Zip ________________
Social Security #______-____-_______ Home phone _______________________
Name ________________________________________________ Title __________________________________________________________________
Home address ___________________________________________________ City ________________________ State ______ Zip ________________
Social Security #______-____-_______ Home phone _______________________
OPENING DATE (Date business activity commenced in or with the City of Tacoma)__________________________________________
Name of Business (dba)______________________________________________________________________________________________________
Describe in detail business activity; principal product sold or service provided______________________________________________
_____________________________________________________________________________________________________________________________
Is business located in the City of Tacoma? Yes ❐ No ❐ If yes: Is the location leased? Yes ❐ No ❐
Is business operated from your home?
Yes ❐ No ❐ Number of Full-time Employees ________ Sq. Ft. of Location ________
Do you provide gambling activities?
Yes ❐ No ❐ Do you charge for admission? Yes ❐ No ❐
Do you own or operate any of the following mechanical devices? Amusement: Yes ❐ No ❐ Music: Yes ❐ No ❐ Pool Table: Yes ❐ No ❐
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TXL 184 05 12/11 b
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