Please check one of the following:
New Application
Change of Ownership
Renewal
Business Name:
Corporation Name:
Business Location:
Mailing Address:
Phone Number:
Description of Business:
(Designate whether Retail, Wholesale, Manufacturing, Etc.)
State UBI Number:
Contractor's License Number:
Owner's Name:
Home Address:
Home Phone:
New Business License Application $50.00
Business License Renewal $25.00
Late Business License Renewal $50.00
Estimated Annual Sales of less than $2,000 FREE
Total Amount Due
I hereby declare under penalty of perjury, that the above information is true and correct.
Signature: Date:
Printed Name: Title:
Date Paid: Business License #
Amount:
Please check the following as it applies to your business
For Official Use Only
CITY OF COSMOPOLIS
ANNUAL BUSINESS LICENSE APPLICATION
PO BOX 2007, 1300 FIRST STREET
COSMOPOLIS, WA 98537
(360) 532-9230
All Fees are Due by January 31st and are for the Calendar Year
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signature
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