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1469 ****** PLEASE FILL OUT FORM COMPLETELY DO NO LEAVE ANY BLANKS ******

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****** PLEASE FILL OUT FORM COMPLETELY. DO NOT LEAVE ANY BLANKS ******
CITY OF ELOY
BUSINESS LICENSE APPLICATION
624 NORTH MAIN STREET
ELOY, AZ 85131
Phone: 520.464.3401 Fax: 520.466.3760
_____________________ ________________________
TPT TAX # Register of Contractor # (Roc)
TAX PRIVILEGE TRANSACTION #
Mobile Business ___Yes __No
PLEASE TYPE OR PRINT LEGIBLY:
Assessor’s Parcel No: _____________________________ (City Limits Only-License will not be issued without number)
Business Name: ____________________________________ DBA: _____________________________
Business Location: ___________________________________ City/State/Zip: _____________________
Business Mailing Address: _____________________________ City/State/Zip: _____________________
Business Telephone: _______________________ Fax: ________________ Email: _________________
Date Business Began: ____________ Classification: Individual ____ Partnership___ Corporation: _____
Is property location of Business owned by the Business: ______ Yes ______ No
If no, give name and address of Property Owner: ____________________________________________
____________________________________________________________________________________
Previous Owner: ________________________________ Previous Use: _________________________
Are you proposing new additions/changes to the Structure: ______ Yes ______ No
I Understand that the issuance of a Business License by the City of Eloy does not necessarily mean
that my business has complied with County, State and Federal requirements which may apply to my business.
I Certify that the information contained on this application is true and correct to the best of my
knowledge.
_________________________________________________________ _________________________
SIGNATURE DATE
____________________________________________________________________________________
FOR OFFICE USE ONLY
FEE PAID ____ No ___ Yes Business Name Change $ ______
Date paid: ________________ Check ____ #_______ Cash ____ Annual $__________ Prorated $ _________
DEPARTMENT
INITIALS
APPROVED
DENIED
COMMUNITY
DEVELOPMENT
DIRECTOR
BUILDING OFFICIAL
P.W. DIRECTOR
POLICE CHIEF
CODE ENFORCEMENT
FIRE DISTRICT
FINANCE DIRECTOR
Date received by Finance Department: ________________________________
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- 2-
ZONING USE QUESTIONNAIRE
(FOR BUSINESS LICENSE APPLICATIONS)
Consideration of your request for a City of Eloy business license requires the following
information for the Planning and Zoning Division in order to determine the legality of your
proposed use of property:
Business Type: _______________________________________________________________
Please explain in detail what type of work will be done: ________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Will your business occupy a permanent structure in the City of Eloy? _____ Yes _____ No
If no, please explain the location of the property that will be used for the business:
____________________________________________________________________________
____________________________________________________________________________
Is the structure a residence or a commercial or industrial building? _______________________
Do you own your business premises? _____ Yes _____ No
If no, provide property owner’s name, address and phone number and attach a notarized
written consent form or a lease agreement (City Limits Only):
____________________________________________________________________________
____________________________________________________________________________
Check one: New Business New Owner - Existing Business
Existing Business - New Location Existing Business - New to Eloy
Existing Business - Lapsed License Existing Business – Address Change
Existing Business – Additional Business Activity
The issuance of a business license does not grant any rights to violate any provision of the zoning ordinance. There
are very specific limitations on the use of a residence for business activity. Similarly, possession of a business
license for a “Mobile” business does not confer the right to set on public or private property without the written
consent of the owner in possession. Construction services offered to the public also require a contractor’s license.
- 3-
CITY OF ELOY
BUSINESS LICENSE INFORMATION
Name of Business Owner/Operator: _________________________________________
Home Address: _________________________________________________________
City: __________________________ State: _____________ Zip: _______________
Telephone: ___________________ Fax: ______________ Email: _________________
Social Security#: __________________________ Date of Birth: __________________
Driver’s License #: ___________________________ State of Issuance: ____________
Height: ___________ Weight: ___________ Hair: ___________ Eyes: _____________
EMERGENCY CONTACT DURING NON-BUSINESS HOURS:
Name: __________________________________ Telephone #: __________________
Address: ______________________________________________________________
*APPLICANT(S) IS (ARE) SUBJECT TO A CRIMINAL HISTORY
BACKGROUND CHECK*
- 4-
CITY OF ELOY
POLICE DEPARTMENT
EMERGENCY RESPONSE LIST
BUSINESS NAME: ________________________________________________
ADDRESS: _______________________________________________________
BUSINESS TELEPHONE NUMBER: __________________________________
OWNER: ________________________________________________________
HOME ADDRESS: _________________________________________________
PERSONS TO CALL IN ORDER OF PREFERENCE
1. NAME: ____________________________ PHONE: ________________
2. NAME: ____________________________ PHONE: ________________
3. NAME: ____________________________ PHONE: ________________
4. NAME: ____________________________ PHONE: ________________
5. NAME: ____________________________ PHONE: ________________
BUILDING TYPE: (Masonry), (Frame), (Other) ?______________________
ALARM SYSTEM: Yes ________ No ________ Type? ______________
HAZARD MATERIAL: Yes ________ No ________
OPERATING HOURS: __________________ - __________________
OPERATING DAYS: ___________________ - _________________
(Revised 9/29/2011)
City of Eloy
Finance Department
628 North Main Street
Eloy, Arizona, 85131
Licensing Eligibility Requirement Form (ARS § 41-1080)
Effective October 1, 2008, a new law went into effect preventing the City from issuing a license (either new or
renewed) to an individual unless the individual has provided the City of Eloy with one of the forms of
identification listed below. If your business is incorporated, provide a certificate of good standing.
To become or remain eligible for a license, complete this form and present one of the forms of identification as
listed below to the City of Eloy’s Finance Department for processing. Please indicate which form is presented.
An Arizona driver license issued after 1996 or an Arizona non-operating identification
A driver license issued by a state that verifies lawful presence in the United States. (Licenses
from HI, IL, ME, MD, NM, TX, UT and WA are not acceptable.)
A birth certificate or delayed birth certificate issued in any state, territory or possession of the
United States.
A United States certificate of birth abroad.
A United States passport.
A foreign passport with a United States visa.
An I-94 form with a photograph.
An United States citizenship and immigration services employment authorization document or
refugee travel document.
A United States certificate of naturalization.
A United States certificate of citizenship.
A tribal certificate of Indian blood.
A tribal or Bureau of Indian Affairs affidavit of birth.
Corporate certificate of good standing
By my signature below, I hereby certify, under penalty of perjury, that I am legally authorized to be present in
the United States.
_____________________________________ __________________
Full Signature of Licensee Date
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Completed 12 July 2020

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