Author: Stephanie Lamore

CITY OF EMMETT 501 E. MAIN STREET, EMMETT, ID 83617 PHONE 208-365-6050—FAX 208-365-3064
2022 BUSINESS REGISTRATION APPLICATION

APPLICATION TYPE: New Application $25 Renewal $10 Change of Information

ACTIVITIES REQUIRING A BUSINESS LICENSE: Trades, businesses, entities, or activities, including home
occupations that hold themselves out to the public as businesses, trades or professions and which have a fixed place of business within the city limits are subject to the requirements of the Business License Ordinance.

Legal Business Name: ___________________________ Type of Business: ____________________________
Business Name-DBA: _______________________________________________________________________
Street Address: ________________________ Emmett, ID 83617 Phone: ____________________________
Mailing Address: ______________________ City: __________________ State: _______ Zip: ___________
Email: ___________________________________________________________________________________

Business Owner’s Name: ____________________________________________________________________
Address: _________________________ City: _________________ State: ________ Zip: ______________
Phone: _________________________________ Other Phone: ____________________________________
Email: ___________________________________________________________________________________

Manager’s Name: _____________________________________________ Title: _______________________________ (If different than owner) Phone: _______________________ Other Phone: ______________________

Emergency Contact Name: ______________________ Phone: _________________ Other Phone: _______________
Emergency Contact Name: ______________________ Phone: _________________ Other Phone: _______________
Emergency Contact Name: ______________________ Phone: _________________ Other Phone: _______________
_________________________________________________________________________________________________

* Please help our fireman and emergency services by providing the following information:
Do you have any flammable or hazardous material? Yes _________ No _________ If yes, general location _____________________________________________________________________________
Do you have an alarm system? Yes _________ No _________ Do you have a video system? Yes _________ No _________

I hereby certify that I have read and examined this document and know the same to be true and correct.

Owner or Authorized Agent Signature: ____________________________________________________ Date: __________________________

*This information may not and will not be used for any code enforcement measures. This information is only for the safety of our emergency personnel and to help us keep you and your property protected. See Idaho Constitution Article XII, Section 2.

Gordon W. Petrie, Mayor