License for Calender Year:

Business Name:

Business Location Address:

Business Location City State Zip:

Business Mailing Address:

Business Mailing City State Zip:

Business Phone:

Owner(s) Name:

Owner Mailing Address:

Owner Mailing City State Zip:

Owner(s) Home Phone:

Emergency Name and Phone:

Email Address:

Description of Business:

Oregon Contractor's Board Registration # or Tax ID #:
(if applicable)

Business Type: Home Occupation Sole Proprietor Partnership Corporation LLC Non Profit (no fee)

Authorized Signature:

Today's Date:

NOTICE:

Acceptance of business license application does not certify that applicant has complied with all City Code provisions.