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License No.: BUSINESS LICENSE FEE: call 253-931-3090 All licenses expire June 30. Renewal notices are mailed in May. Business licenses are not pro-rated and are non-transferable. If
you discontinue your business activity in Auburn, please notify the Permit Center at (253) 931-3090. PLEASE RETURN TO: Auburn Permit Center 25 West Main Street Auburn, WA 98001 Phone:
(253) 931-3090 Fax: (253) 804-3114 New Business: New Location: New Owner: Name Change: Outside City: CITY OF AUBURN APPLICATION FOR BUSINESS LICENSE Auburn City Code requires
each business operating within the city limits to obtain a business license. Additional individual licenses are required for the following business activities: Ambulance Services; Amusement
Device(s); Auto Races; Cabaret; Carnival, Circus, Show; Dance; Fire Extinguisher Service; Fireworks Stand; Motor Vehicle Wreckers; Outdoor Musical Entertainment; Pawnbrokers/Secondhand
Dealers; Solicitor; Tow Truck and Tow Truck Driver. DOING BUSINESS AS Name: Address, Suite #: City, State, Zip: LOCAL BUSINESS PHONE NO: BUILDING OR PLAZA NAME: OPENING DAY OF BUSINESS:
LICENSEE MAILING ADDRESS (IF DIFFERENT FROM BUSINESS ADDRESS) (All information related to this license will be sent to this address) Name: Title: Address, Suite #: City, State, Zip:
CORPORATE/BUSINESS PHONE: BUSINESS FAX: WEB SITE (if applicable) E-mail address: COMPLETE THIS SECTION FOR MAJORITY OWNERS, AGENTS, PARTNERS OR CORPORATE OFFICERS 1) NAME: ___________________________
______________HOME ADDRESS: TITLE: __________________________________ CITY/STATE/ZIP: % OWNED _______________ HOME PHONE:: DATE OF BIRTH: DRIVER’S LICENSE #: EMERGENCY CONTACT? Yes No
2) NAME: _________________________________________ HOME ADDRESS: TITLE: __________________________________ CITY/STATE/ZIP: % OWNED _______________ HOME PHONE: DATE OF BIRTH: DRIVER’S
LICENSE #: EMERGENCY CONTACT? Yes No In the event of an incident at your business, you are required to provide an individual who can be contacted at all times: LOCAL RESPONSIBLE CONTACT
_________________________________________ HOME ADDRESS: TITLE: _______________________________CITY/STATE/ZIP: BUSINESS PHONE: ________________ HOME/CELL PHONE: ________________ DATE
OF BIRTH: DRIVER’S LICENSE #: EMERGENCY CONTACT? Yes No FOR OFFICE USE ONLY: Date received: Prior License # _____________________
BUSINESS INFORMATION: FEDERAL TAX ID #: WA STATE UBI/TAX #: CONTRACTOR ID #: If applicable NAICS Code: (note: if you don’t know this code, it can be obtained from the Washington State
Department of Revenue at www.dor.wa.gov) LEGAL STATUS: Sole Proprietor Individual Corporation LLC Partnership Other______________ NUMBER OF EMPLOYEES LOCATED AT YOUR
PLACE OF BUSINESS WITHIN THE CITY OF AUBURN: ________ BUSINESS ACTIVITY Your business will engage in which of the following activities? (check all that apply): Wholesale Retail
Service Manufacturing Finance/Insurance Government Education Health Care Transportation/Communications/Utilities Food Processing Food Service Construction type __________________
Please describe your business activities in detail; list principal products sold, services provided, etc): ____________________________________________________________________________________________
___ _______________________________________________________________________________________________ _______________________________________________________________________________________________
TELECOMMUNICATIONS PROVIDER? Yes No; if yes, complete Telecommunications Form INDIVIDUAL LICENSE REQUIRED? Yes No; if yes, complete appropriate Individual License Application HOME OCCUPATION?
Yes No; if yes, complete Home Occupation Form Is this a Non-Profit Organization exempt from taxation under 26 USC 501(c)(3) or (4)? Yes No If yes, please provide a letter from the IRS
stating the exemption. BUSINESS LOCATION INFORMATION (only if inside the city limits) Assessor’s Parcel #: Building: Single Tenant Multi Tenant Property Owner/Leasing Agent: Name: ___________________
____________________________ Address:______________________________________________ City/State/Zip: _________________________________________ Telephone: ___________________________________________
Business Sq. Ft.: Total Building: Storage/Warehouse: (how much of the total bldg.): Property Sq. Ft.: Are you making tenant improvements?: Yes No (Some improvements may require permits.
Please contact the Permit Center for additional information). Are you the first tenant at this location? Yes No If no, name of previous business at this location and/or type of use this
business is replacing: _______________________________________________________________Residence Retail Light Industrial Warehouse Other, describe _____________________________ STORE
HAZARDOUS MATERIALS? Yes No If yes, complete a Hazardous Materials Inventory Statement. For questions, please contact the Valley Regional Fire Authority at (253) 931-3060 APPLICANT’S
SIGNATURE I hereby certify and declare under penalty of perjury under Washington law that the statements furnished by me on this application are true and complete to the best of my knowledge.
I understand that the issuance of a business license is conditioned upon compliance at all times with all applicable ordinances, regulations and statutes of the City of Auburn and the
State of Washington. The issuance of a a business license does not imply compliance with the Zoning Code and International Fire and Building Codes. Date Signature Title