Web Form - Business License Application

* Indicates required field

City of West Burlington

City Hall, 122 Broadway St.

Ph: (319) 752-5451 Fax: (319) 752-8425

BUSINESS LICENSE APPLICATION

APPLICANT INFORMATION

* Applicant Name:

* Applicant Phone:

* Applicant Email:

BUSINESS INFORMATION

* Business Name:

* Business Address:

* Business City, State, Zip:

* Business Phone:

* Billing Email:

* Is there off street parking?:

* Is parking on a durable and dust free surface?:

“Durable Hard Surface - means a surface consisting of Portland cement concrete or asphalted concrete, providing an adequate base to support the traffic and/or materials for which the area is designed.

SITE INFORMATION

**Attach a detailed drawing showing the location you will be conducting business on the property.

If No, Attach a letter granting permission to use the property along with property owners name and contact information.

For Temporary License Requests:

If you are applying for a Temporary Business License please list the dates and times you will be conducting business:

First:

Start Date:

Hours:

Expiration Date:

Second:

Start Date:

Hours:

Expiration Date:

Third:

Start Date:

Hours:

Expiration Date:

SIGNATURE

I do hereby certify that the information contained herein is true and correct.

* Signature:

* Print Signature:

For Food Vendors:

Please also upload the following

<> Site Permission Slip

<> Health Permit

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