Laserfiche WebLink
-------------------------- --..----------..-..-..--------------------- <br />City of Gem Lake <br />Heritage Hall <br />4200 Otter Lake Road I Gem Lake, MN 55110 <br />651-747-2790/92 1 651-747-2795 (fax) <br />E-mail city@gemlakemn.org <br />Business License Application <br />All businesses with the intent to operate in the City must first obtain a Business License issued by the City of Gem Lake per City Ordinance No. 136 <br />Instructions: <br />1. Complete entire application. Please print legibly or type. <br />2. Do not leave any lines blank, Use "N/A" if it is "not applicable" to your business. <br />3. Sign and date completed application <br />4. Send completed application, workers' compensation certificate of compliance form and $100.00 business license fee to the <br />address / email address indicated above. If emailing please call with credit card payment or send check. <br />Choose: New Business Renewal <br />Where w 1 you like your Business License sent? 0 Electronically Business Address Mailing Address <br />Local Contact Information <br />Name of Business: <br />DBA: N J <br />Business Address: <br />Business Type: / W <br />Number of Employees: <br />City: �� V1 ti��- ✓✓V� Q State: �jy Zip: <br />Mailing Address (only if different): ��1� ► t�/iy� Iy <br />City: & 0 a "l./` State: ! - 1 I\i Zip: 5--M d <br />BusinessPhone: l�' 'fit ax: Email: <br />Federal Tax ID #: �j ` �MN Tax ID #: 0050 Business Hours: '4ow <br />Do you have an Automated External Defibrillator (AED) on site? ElYes 2kNo If yes, how many? <br />Primary Business Contact Person <br />Name: A \f'%1/ Daytime Phone: (PSI1 <br />Title: h/\ p A/' Email: <br />Key Holder Contact Information (after hours emergency contact) <br />Primary Key Holder: �� AAeW Secondary Key Holder: 0��� l �n <br />Home Phone: / Home Phone: ((// <br />Cell Phone: b 5l -72 - " )� � Cell Phone: <br />Alarm & Security System Information <br />Alarm Company: <br />Dispatch Phone #: <br />Signature Required <br />I hereby certify that the above information is accurate. In the event that the above information should change I will notify the City within 30 days of <br />said change. I understand deposit of the check does not constitute the issuance of a City Business License. An inspection of your business must be <br />completed and passed before your business license will be approved and issued. I understand that the application fee is non-refundable. Upon license <br />being granted, the undersigned agrees to comply with all Ordinance, rules and regulations of the City of Gem Lake. <br />Print Name: <br />Signature: <br />Date: <br />i <br />- ------------------------------------------------------------- <br />