HomeMy WebLinkAboutBUSINESS LICENSE - 22-00127 - Ethereal VR LLC Arcade.pdf
Office Us e Only Registration No. ________
Fees Paid
(Use Explorer to Email) SIC (NAICS)
APPLICATION FOR CERTIFICATE OF BUSINESS REGISTRATION
No person shall maintain or operate any business, trade, or occupation within the corporate limits of the City of Rexburg
without first obtaining a Certificate of Registration from the City of Rexburg and paying a general fee. Certificates of
Registration shall be issued to each applicant complying with all applicable state laws and city ordinances.
GENERAL INFORMATION
APPLICATION PURPOSE New Business Renewal New Location N e w O w ner Remodel Other Change
LEGAL NAME OF BUSINESS
TRADE NAME (doing business as) STATE TAX ID #
TYPE OF BUSINESS (Check One) Sole Proprietor Corp. LLC Partnership Other
NATURE OF BUSINESS (Check all that Apply) Manufacturing Wholesale Retail Services Food Services
Professional Contractor/Trade Rental (Appendix A) Beer (Appendix B) Fireworks (Appendix C) Peddler,
Solicitor, Itinerant Merchant or Mobile Vendor (Appendix D) Home Occupation (Appendix E) Pawnbroker or
Secondhand Dealer (Appendix F) Booting GA (Appendix GA) Towing (Appendix GB) Wine (Appendix H)
Use of City Sewer (Appendix I & J) Public Transportation (Appendix K)
DESCRIBE IN DETAIL THE PRINCIPAL PRODUCT(s) OR SERVICE(s) RENDERED:
Business Web Address:
CONTACT INFORMATION
APPLICANT’S DRIVERS LICENSE NO. ____________________________________________ State _______________
NAME OF OWNER/APPLICANT Phone
Address _ Email
NAME OF PROPERTY OWNER Phone
Address _ Email
AFTER HOURS EMERGENCY CONTACT Phone
Address _______________________________________________________________ Email
SITE DESCRIPTION
ZONING APPROVAL: Date Obtained Zoning Approval by: (Contact City Hall at 372-2163
to obtain zoning and signage requirements)
PHYSICAL BUSINESS ADDRESS
Please indicate if you approve providing this physical address, web address, and/or phone no. to the city’s web site:
Yes No
MAILING ADDRESS BUSINESS PHONE
SIGNAGE: Applicants wanting a sign must apply for a sign permit. Applications are at City Hall or at www.rexburg.org.
Ethereal VR LLC
87-2009477
LLC
We are an Arcade that exclusively uses Virtual Reality (VR) games.
Jamal Taylor 2027060807
125 Valley River Dr maltaylor2014@gmail.com
Chung Kin Chan
2270 Worthing Lane, Los Angelas CA 90077 ckproperties888@gmail.com
125 Valley River Dr
555 W Mikan Dr 2027060807
Colorado17-154-4198
DEVELOPMENT CODE REQUIREMENTS
STAFF REVIEW:
Development Code Approval by: (Contact City Hall at 359-3020 to obtain approval)
WASTEWATER PERMITTING & BUILDING COMPLIANCE
What type of business will be performed?
**Will the business have food preparations? Yes No
**Will there be any cooking of foods? Yes No
**Will there be any deep fat frying? Yes No
**Will you have food disposal on site? Yes No
Will there be any maintenance or mechanical work in the building? Yes No
**Will there be sumps or floor drains in the facility? Yes No
Will the business require more parking? Yes No
**Will the business have any chemicals on site? Yes No
Is this business occupying an existing building? Yes No
Will the business be doing any structural/or remodeling changes to the building? Yes No
Any changes to the electrical? Yes No
**Any changes to the plumbing? Yes No
Is this business planned to be the same with different ownership? Yes No
Will there be a change of occupancy? Yes No
I certify that the information that I have provided above is to the best of my knowledge accurate and true.
**IF YOU ANSWERED YES TO ANY OF THESE QUESTIONS, PLEASE COMPLETE APPENDICES I AND J.
IMPORTANT: Incomplete or incorrect applications may result in delay or refusal of issuance of Certificate of Registration.
Except where otherwise provided, the certificate year/term shall run from January 1st until December 31st of the same year.
The certificate must be renewed yearly and the applicable fees must be paid yearly.
AS APPLICANT, I , DECLARE UNDER PENALTY OF PERJURY
UNDER IDAHO STATE LAW THAT ALL INFORMATION GIVEN IS TRUE AND CORRECT, AND I UNDERSTAND THAT
ALL INFORMATION GIVEN IS SUBJECT TO VERIFICATION.
Applicant’s Signature Phone Date
*PLEASE ATTACH ANY APPLICABLE APPENDIX (See general information above), AND ENCLOSE A CHECK FOR ALL
APPLICABLE FEES MADE PAYABLE TO THE CITY OF REXBURG.
OFFICE USE ONLY - APPROVAL CHECKLIST – PLEASE INITIAL
CODE REVIEW ECON DEV FIRE DEPT CITY CLERK WASTEWATER
Arcade
Jamal Taylor
202-706-0807 10-22-21Jamal Taylor
Verified by pdfFiller
10/22/2021