Boyd3992 BUSINESS LICENSE APPLICATION FORM
Send Completed Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION
P.O. Box 1504
La Quinta, CA 92253
r
1. Business Name: 2,e DO- _"" /�_�
2. Business Address: .k-'4// c/(` /�., _ _ -
3. Mailing Address:
I IIIIII VIII IIII IIII
26
BUS. LIC. NO.
to ie 9P 14
ASH S. NOTAL i L 25.00
4. Business Phone:
5. Owned By: CORPORATIONN PARTNERSHIP INDIVIDUAL
�6. If Corporation or Partnership: Tax I.D.#
7. If Individual Owner: Social Security #
8. Name of Owner or Officers and Title:
9. SBE Resale Number:
10. Number of Decals Needed:
11. CONTRACTORS ONLY:
A. Type of Contractor: _
B. Classification:
C. State License Number :
CONTRACTORS - GENERAL $100.00 Per Year
CONTRACTORS - SUB $ 50.00 Per Year
or $ O.00 Semi-annual
or. $25.00 Semi-annua
CONTRACTORS ARE ON A CALENDAR YEAR BASIS ONLY; ANNUAL FROM JANUARY 1ST
THROUGH DECEMBER 31ST. SEMI-ANNUAL FROM JANUARY 1ST THROUGH JUNE 30TH; OR
JULY 1st THROUGH DECEMBER 31ST.
41*'HEREBY CE TIFY that all t information supplied by me is correct and
any licen s required 1i e County, Staff or Federal Government have been
issued o me and are a. full force and ,dff�ct.
signatur
- Date