I. BUSINESS INFORMATION:
DOING BUSINESS AS (NAME ON SIGN): BUSINESS WEBSITE ADDRESS:
BUSINESS LOCATION ADDRESS:
SUITE #:
CITY: STATE: ZIP:
SQUARE FOOTAGE OF SPACE: BUSINESS EMAIL: OPENING DATE:
BUSINESS PHONE: BUSINESS CONTACT NAME, TITLE:
IV.BILLING INFORMATIONIF DIFFERENT THAN SECTION I:
ADDRESS: CITY: STATE: ZIP:
PHONE NUMBER:
III. BUSINESS OWNERSHIP STRUCTURE THIS BUSINESS IS A:
Individual Business Partnership Corporaon Limited Liability Company Nonprot Associaon
V. LANDLORD INFORMATION (IF THE SPACE IS RENTED):
COMPANY: CONTACT PERSON:
ADDRESS: CITY: STATE: ZIP:
PHONE NUMBER: EMAIL ADDRESS:
Business License/Registraon Applicaon
Community Development Department
Village of Niles
1000 Civic Center Dr., Niles, IL. 60714
(847) 588 - 8040 | F: 847-588-8050 | www.vniles.com
APP DATE: LICENSE FEE:
OFFICE USE ONLY
APPROVALS
ZONING: LICENSING: FIRE:
DATE: DATE: DATE:
QTY: CODE: SERVICE:
LICENSING REQUIRED
OFFICE USE ONLY
II. BUSINESS OWNER INFORMATION
FIRST: LAST: PHONE:
ADDRESS: CITY, STATE: ZIP:
DETAILED DESCRIPTION OF BUSINESS USES/SERVICES PROVIDED:
BUSINESS LEGAL NAME (CORPORATION):
IS YOUR BUSINESS LICENCED IN THE STATE OF ILLINOIS? YES NO IF YES, STATE LICENSE #_______________ (ATTACH COPY).
EXAMPLE: PROFESSIONALS REQUIREDTO BE LICENSED BY THE STATE (I.E. LAWYERS, DOCTORS, REAL ESTATE AGENTS, ARCHITECTS, ETC.)
ILLINOIS BUSINESS AUTHORIZATION NUMBER (SALES/USE TAX# OR EXEMPT #):
FEDERAL EMPLOYEE IDENTIFICATION NUMBER (FEIN):
VI. BUSINESS DETAILSANSWER ALL QUESTIONS BELOW:
1. Is the business a new use in this locaon when compared to the previous occupant? If YES, note previous use:_________________
Example: Opening a restaurant in a locaon that was previously an oce is a new use.
Yes No
Unsure
2. Does this business oer massage therapy to the general public?
Yes No
3. Does this business have coin-in-slot or vending machine devices on the premises? # of Devices:__________________
Yes No
4. Will hazardous materials be stored at this locaon?
Yes No
6. Does this business sell tobacco/e-cigaree products over the counter?
Yes No
8. Will you or have you applied for a building permit?
Work that adds, moves, or exposes water lines, gas, electricity or walls needs a building permit.
Yes No
9. Does this business locaon have or will have a security alarm? Note: A Building Permit is required to install a security alarm.
Yes No
10. Will you be making modicaons/addions to signage? Note: A Sign Permit may be required. Yes No
11. PREPARED FOOD AND ENTERTAINMENT:
A) Is there more than 10% of the business oor area devoted to the same and/ or storage of food/beverages?
B) Does this business sell/serve prepared food or beverages directly to the general public?
C) Does this business use a vehicle to sell prepared food or beverages directly to the general public?
D) Have you applied or will you apply for a liquor license (Village Manager’s Oce)?
E) Restaurants with a bar area, indicate number of seats/barstools_______________
F) Does this business provide amusement and/or entertainment? Sec. 94-280
G) Does this business provide motor fuel/gasoline?
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
VII. EMERGENCY CONTACT INFORMATION
FIRST: TITLE/ROLE: LAST:
ADDRESS, CITY: STATE: ZIP:
HOME/CELL PHONE (CIRCLE): EMAIL:
I understand that as a business owner, I will nofy the Village of Niles should I decide to sell prepared food and/or beverage and/or provide music or entertainment at this locaon.
Sec. 94-250 requires businesses that sell prepared food and/or beverage must collect and remit directly to the Village of Niles the addional 1% food and beverage tax.
Sec. 94-281 requires businesses that provide amusement/entertainment must collect and remit directly to the Village of Niles the addional 3% amusement tax.
Please contact the Finance Department for addional informaon: 847-588-8035
NOTE: If the license has not been issued or picked up within six (6) months of the applicaon date, this applicaon will be considered VOID and a new
applicaon shall be submied.
I DO HEARBY CERTIFY THAT THE INFORMATION CONTAINED IN THIS APPLICATION AND ADDENDUMS (IF APPLICABLE) HAS BEEN FUR-
NISHED BY MYE AND TO THE BEST OF MY KNOWLEDGE IS CORRECT. I UNDERSTAND THAT ANY UNTRUE, INCONSISTENT OR MISLEADING INFORMATION
SHALL BE CAUSE FOR REFUSAL TO GRANT OR THE REVOCATION OF ANY LICENSE GRANTED PURSUANT TO THIS APPLICATION. I FURTHERCERTIFY THAT BY
APPLYING IN WRITING FOR A LICENSE TO OPERATEIN THE VILLAGE OF NILES I HAVE READ AND UNDERSTAND MY OBLIGATIONS UNDER APPROPRIATE
CHANGES DURING THE COURSE OF THE LICENSE YEAR I WILL NOTIFY THE VILLAGE OF NILES, IN WRITING, WITHIN SEVEN (7) DAYS OF SUCH CHANGE.
I WILL CALL COMMUNITY DEVELOPMENT AT 847-588-8040 TO SCHEDULE THE INSPECTION(S) NEEDED FOR THIS BUSINESS LICENCE.
________________________________
Signature
_____________________________________________
Printed Name
___________________________________
Date
FIRST: LAST: TITLE/ROLE:
ADDRESS, CITY: STATE: ZIP:
HOME/CELL PHONE (CIRCLE): EMAIL:
VIII. FIRE ALARM MONITORING INFORMATION
NAME:
TELEPHONE: EMAIL:
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