CITY OF GREEN RIVER
APPLICATION FOR BUSINESS LICENSE
DATE OF APPLICATION____________________________ RECEIPT NO _________________
BUSINESS NAME__________________________________ BUSINESS TYPE______________
LOCATION______________________________________
CITY______________________________ STATE ___________ ZIP CODE ________________
TELEPHONE 1: _______________ TELEPHONE 2: ________________ FAX: ______________
E-MAIL: ________________________________________
MAILING ADDRESS: ______________________________ATTENTION___________________
CITY _____________________________ STATE ___________ ZIP CODE ________________
BUSINESS CLASSIFICATION
□ CORPORATION □ PARTNERSHIP
□ LIMITED LIABILITY COMPANY □ SOLE PROPRIETOR
NAMES, BIRTHDATES, SSN OF ALL PARTNERS, OFFICERS AND DIRECTORS
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OWNER NAME _____________________________
DATE OF BIRTH ____________________ SOCIAL SECURITY NO _______________________
ADDRESS ___________________________ CITY_________________________ STATE_____
TELEPHONE 1: _________________________ TELEPHONE 2: ________________________
MANAGER NAME ________________________________
ADDRESS ___________________________ CITY ________________________ STATE _____
SALES TAX ID: ____________________________________
FEDERAL ID: _____________________________________
STATE ID: _______________________________________
DEPARTMENT SIGNATURE
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DATE INSPECTED |
DATE APPROVED |
**DISAPPROVED
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ZONING ADM |
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BUILDING |
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HEALTH |
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FIRE |
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PLANNING COMMISSION |
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BOARD OF ADJUSTMENT |
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**COMMENTS _________________________________________________________________
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LICENSE ISSUED: _____________________________________________________________
DATE NUMBER