HOTELS -- MOTELS

Fee: 0-50 Rooms $220.00/51-100 Rooms $275.00/101+ Rooms $330.00

(Title II, Chapter 6, Section 14)

NAME OF BUSINESS:______________________________________________________

BUSINESS ADDRESS: _____________________________________________________

NAME OF OWNER: ________________________________________________________

ADDRESS OF OWNER: _____________________________________________________

BIRTHDATE: ___________________________DRIVER LIC.# ______________________

BUSINESS PHONE# _____________________HOME PHONE # ____________________

TYPE OF ESTABLISHMENT:

____Hotel ____Lodging House ____Motel ____Rooming House

____Bed & Breakfast

MAXIMUM NUMBER OF OCCUPANTS: ___________ NUMBER OF UNITS: __________

LOCATION OF UNITS (1st floor, 2nd floor, etc.) ________________________________

STATE SALES TAX LICENSE # ________________________________

_________________________________________ DATE: __________________________

Signature of Applicant

DO NOT WRITE BELOW LINE

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____________________________________ _____approved

Police Chief _____denied

Date: __________________________

____________________________________ _____approved

City Treasurer _____denied

Date: __________________________

____________________________________ _____approved

Zoning Administrator _____denied

Date: __________________________

____________________________________ _____approved

Property Maintenance Inspector

Date: __________________________ _____denied