HomeMy WebLinkAboutBW #3361 CAFE SABORJ 'i Sr
� REXBURG
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
LEGAL NAME OF BUSINESS v J ' "(d/�S lht
TRADE NAME (doing business as)
New Owner _Remodel _Other Change
STATE TAX ID # 0 ! ✓ 66 11-7-9
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 f7 _Towing & Booting (Appendix G) _Wine (Appendix H) _Use of City Sewer (Appendix I & J) _Public
Transportation (Appendix K)
DESCRIBEIN DETAIL THE PRINCIPAL PRODUCT(s) OR SERVICE(s) RENDERED:
1 1AJ/— �Ci/r(Gc Yzf[WtYA4—
Business Web Address: ��fc�lUi'�at�z SbY. Ci/ a
CONTACT INFORMATION
APPLICANT'S DRIVERS LICENSE NO.— /%'e9LIS�%.3 / State l
NAME OF OWNER/APPLICANT t jJft ��� � .—JoCG�vr 1 mr/4'h. Phone 15f 7711^ s�('
Address ��„�ZK. fry a&L (17T S-'132 I Email , G< ®C JAI Y_ 6U
NAME OF PROPERTY OWNER low/ Phone
Address I y !0 834Y0 Email Vw=Gk{J®�IC('7?YY1/✓�CAip
AFTER HOURS EMERGENCY CONTACT J L/�� 1/�� eft � p Phone
(6 � S
Address Z ` E' lam„" f # iI� G M6
ZONING APPROVAL: Date Obtained
3020 to obtain zoning and signage requirements)
SITE DESCRIPTION
Zoning Approval by: (Contact City Hall at 359-
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
�QUIFcEMENTS
DEVELOPMENTiCQDE RE
STAFF REVIEW:
Development Code Approval by: (Contact City Hall at 359-3020 to obtain approval)
WASTEWATER PERMITTING BUII DING'COMPLIANCE
What type of business will be performed: /�C,fTXV
"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?
Yeses
No
**Any changes to the plumbing?
Yes_
No
Is this business planned to be the same with different ownership?
Yes
No
�c
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 151 until December 3151 of the same year.
The certificate must berenewedyearl 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 I RMATION GIVEN IS SUBJECT TO VERIFICATION.
yes= n�- 3363 ��Z��zy
ApplicPs 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.
bFJCE US^E QAILY'� OPPOVfAL CHECKLIST.' _'PLEASE- INITIAL
BUILDING DEPT. ZONING DEPT. FIRE OF-PF. CITY CLERK ____ COMP!_IANCE OFFICEI
- ---------
CUSTOMER SUPPORT
_ •-
.__ __ _......_...... SERVICES
` r 1 1 M`�.d
p T4J../�
35 North V East (PO Box 280) Phone: 208-359-3020 x2313
Rexburg, Idaho 83440 Fax: 208-359-3022
www.rexbura.org blair.kay@rexburg.org
APPENDIX B - APPLICATION FOR RETAILER'S LICENSE TO SELL:
❑ BEER ONLY
❑ WINE ONLY
BEER AND WINE
I (or we) the undersigned, make application fora license to sell beer and/or Mline, as a retailer within
the City of Re.Nburg, Idaho, and for the purpose represent:
The name of the business is:
,a6wY
Address of business: 16 �v - -Z
business to be conducted thereon by the applicant: _
Address of applicant:
f�rvl �G lCrf�[ur��f"
d'e'-4 o t-All,r, A �f3M,
Phone: Y3�-- 7?0_ 736 3 Email: _ JV I' 6 tttitiH� 1?+f Sct60:-- Cry
Length of residence in the State of Idaho: y0 ►h-r.
I am applying; for a beer and/or wine license to sell: (on premises); ❑ (off premises)
Ordinance 942.-
-1. (Off premises) here the applicnnl applies fir a license to sell as a retailer; only bog//erg or canned beer
and rrune, crone of n bich is consirnied, or to be convinled, on /lie preniiser where .cold, the license Fee
shall be $50.00 for beer and $90.00 for ivine per year zrntil such fee is ai»cadcd Gy rr..rolation
of tyre Council.
B. (On premises) where llie crpplicanl applies fbr a license to .roll beer arrd/or mire ar a relailerfbr• consrrlrll l.*orr nn
/irriirises.
1. L)rrrft beer and bolded or canned beer only, Me aaiorurl rf'lh. a license fee shall be $200.00
per, year; or if
?. Botlled, board or canned wine only, t/_re amolrrrt of the license fee shall be $200 00per year.
.(Vote. 77re license year• br.?girrs Oclolrer 01" and ends ,Seplernher 30'''. 77)e fee mill lre prcrralyd to (50'%)• for a ba f yern-
rvilh applicalions rfleeMarch 31".
1
(d) That the applicant, if an individual, is not less th'm nineteen (191 years of age;
(e) That within three (3) years immediately preceding the date of filing; the
application, the applicant has not been convicted of the violation of any law of the
State of Idaho, any other stare, or of the United State, regulating, governing; or,
prohibiting; the sale, manufacture, transportation or possession of alcoholic beverages
or intoxicating; liquors, or within said time, suffered the forfeiture of a bond for
failure to appear in answer to chat;t;es of any such violation;
(� That within five (5) years immediately preceding the (late of filing; the
application, the applicant has not been convicted of any felony or paid any fine or
completed any sentence of confinement therefore within said time;
(};) That within three (3) years next, preceding the date of filing; the application,
the applicant: has not had any license provided for herein, or any license or permit
issued to the applicant pursuant to the law of this state or any other state, or of
the United States, to sell, manufacture, transport or possess beer, revoked.
That I will observe all requirements of the City of Rexburg; relating to the hours of closing and will
not sell or dispense beer in violation of any such ordinance.
I FURTHER DECLARE that I have read the foregoing application, that I understand the same
and agree to allstategjents therein contained.
Signature:
Revised: July 3, 2017
Date: 3126 12 T
Blair D. Kay, City Clerk
3
THIS LICENSE MUST BE CONSPICUOUSLY DISPLAYED
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