FOR OFFICE USE ONLY
`
Applicant Signature
Print Name
Title
E-Mail
Phone #
Date Signed
LEGAL BUSINESS NAME
WA STATE UBI#
BUSINESS OR TRADE NAME (DBA)
STATE LICENSE #
PHYSICAL ADDRESS OF BUSINESS
BUSINESS PHONE
MAILING ADDRESS OF BUSINESS Check if same as physical address
BUSINESS LICENSE CONTACT NAME
PHONE
EMAIL ADDRESS
TAX CONTACT NAME
PHONE EMAIL ADDRESS
LOCAL EMERGENCY CONTACT
(OTHER THAN ABOVE OR OWNER)
PHONE
EMAIL ADDRESS
BUSINESS ENTITY TYPE COMMERCIAL BUSINESS DES MOINES BASED BUSINESS
Individual/Sole Proprietorship Corporation Partnership LLC Non-
Profit 501 Government Entity
First Activity Date in Des Moines
Projected Des Moines Revenue
Number of Employees working in the
City of Des Moines
Nature of Business (Check All That Apply)
Retail Manufacturing-Extracting
Service Utility
Wholesale Sales Office
Printing/Publishing Door to Door Sales (Solicitor)
Mobile Food Vendor MWBE Certified
Other
Detailed Description of Principal Business Activity in Des Moines
DATE
Amount Paid
Payment Type
NAICS
Registration #
Check all that apply:
In City Business Outside City Business (Businesses located in another city, but entering Des Moines to engage in business)
Adult Famliy Home Family Daycare Property Rental - # of Units_______
New Business Additional Location Location Change New Ownership Name Change
Des Moines Municipal Code 5.04.020 requires all persons wishing to conduct any business within the City of Des Moines to first secure a City of Des
Moines business license. I understand that I am responsible for notifying the Finance Department of any change in the status of my business as well
as any new mailing addresses. I declare under the penalty of perjury that the information provided on this application, is true and accurate. I
understand my place of business must comply with Federal, State and local codes and ordinances.
Des Moines Business License Application
21630 11
th
Ave S. Suite A, Des Moines, WA 98198
Phone: 206-870-7582
Email address: taxandlicensing@desmoineswa.gov
In City Annual License Fee: $75.00 - After July 1
st
: $37.50
Outside City Business Annual License Fee: $100.00 - After July 1
st
: $50.00
FILL OUT THIS FORM COMPLETELY (INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED)
Permits may be required from the Building Department for your proposed use, operation or remodeling.
Please call South King Fire & Rescue at 253-946-7318 to schedule a fire inspection.
Prior to commencing your business, you may be required to meet with South King Fire & Rescue and/or
the City Community Development team as to whether your business will meet all applicable City codes
for the type of business proposed.
Providing valid email addresses will ensure electronic communications will be received from the City.
*How many customers do you expect weekly? _______
*What is the square footage of the business? _______
*Proposed interior/exterior modifications?
Have you been registered as a business within the City?
YES NO
Des Moines Business License Application
City of Des Moines, Washington
WILL YOUR BUSINESS HAVE ANY OF THE FOLLOWING (*MUST COMPLETE if your business is located in Des Moines)
*Will you be operating any of the following
(circle those that apply): adult cabaret, public dance,
massage, panorama device, pawnbroker, secondhand
dealer, solicitor
CHECK & COMPLETE ONE
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