LODGING HOUSES -- ROOMING HOUSES
Lodging
House/Rooming House Fees: $135.00 plus $11.00/each room
(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
-----------------------------------------------------------------------------------------------------------------
____________________________________ _____approved
Police Chief _____denied
Date:__________________________
____________________________________ _____approved
City Treasurer _____denied
Date:__________________________
____________________________________ _____approved
Zoning Administrator _____denied
Date:__________________________
____________________________________ _____approved
Property Maintenance
Inspector _____denied
Date:__________________________