Business License Application

Note: Licenses must be renewed in January every year, expires on January 31^st of each year-Fee $25.00

Application and permit are good only for one year, and are not transferable or assignable.

Applicant agrees to abide by all the Village of East Rockaway Codes and regulations.

NAME OF BUSINESS:

BUSINESS OWNER:

BUSINESS ADDRESS:

BUSINESS EMAIL:

BUSINESS PHONE:

PROPERTY OWNER:

OWNER ADDRESS:

OWNER PHONE:

OWNER EMAIL:

EMERGENCY CONTACT PHONE:

MERCHANDISE TO BE SOLD:

DESCRIPTION OF PROPOSED BUSINESS

FLAMMABLE/HAZARDOUS MATERIALS ON PREMISES: (LIST PRODUCT & AMOUNT)

FLAMMABLE:

HAZARDOUS:

PROPERTY ZONE: (CHECK ONE)

RESIDENCE A ☐ RESIDENCE B ☐ COMMERCIAL A ☐ INDUSTRIAL A ☐ INDUSTRIAL B ☐

WATERFRONT ☐ WATERFRONT COMMERCIAL ☐ COMMERCIAL RECREATION ☐

The Village Code can be found on our website at www.VillageofEastRockaway.org. As part of the licensing approval process a site visit by our Village inspector is required. Please note that it is important to adhere to the regulations set forth by our municipality. Any construction or alteration to the designated space must be accompanied by a valid building permit. To schedule a site inspection or if you require further clarification regarding the building permit process, please contact our office at 516-887-6310 Monday through Friday, 8:00 a.m. to 3:45 p.m.

Checks should be made payable to Inc. Village of East Rockaway.

Signature Date: