AP
PLICATION
FOR
POWHATAN COUNTY BUSINESS LICENSE
PL
EASE APPLY IN THE OFFICE OF THE COMMISSIONER OF THE REVENUE.
A LICENSE IS NOT REQUIRED UNTIL YOU EXCEED $ 3,000.00 IN GROSS RECEIPTS IN
LICENSE TAX YEAR.
LICENSE FEE: $ 50.00 LATE PAYMENT PENALTY: $ 10.00
LICENSE TAX YEAR SHALL COMMENCE WITH JANUARY 1
ST
AND END DECEMBER 31
ST
.
RENEWAL DEADLINE IS MARCH 1
ST
PLEASE COMPLETE ENTIRE APPLICATION AS IT APPLIES TO THE BUSINESS, USING N/A
WHERE IT DOES NOT APPLY. YOUR BUSINESS MUST BE PROPERLY ZONED BEFORE YOU
MAY BEGIN OPERATING. YOU MUST HAVE SECTION 4 OF THIS APPLICATON
COMPLETED BY THE COUNTY ZONING OFFICIAL/ BUILDING OFFICIAL BEFORE WE
CAN ISSUE YOUR LICENSE. IF YOU HAVE ANY QUESTIONS ABOUT THE ZONING, PLEASE
CALL (804) 598-5623. IF YOU HAVE ANY QUESTIONS ABOUT BUILDING USE, PLEASE CALL
(804)-598-5622.
ALL TRADE / ASSUMED NAMES MUST BE REGISTERED WITH THE CLERK OF THE
CIRCUIT COURT OF YOUR LOCALITY BEFORE THIS LICENSE CAN BE ISSUED. PLEASE
BRING A COPY OF YOUR REGISTERED CERTIFICATE WITH YOU WHEN APPLYING.
VIR
GINIA LAW REQUIRES EVERY EMPLOYER WHO REGULARLY EMPLOYS THREE OR
MORE FULL-TIME OR PART-TIME EMPLOYEES TO PURCHASE AND MAINTAIN WORKERS’
COMPENSATION INSURANCE. EMPLOYERS WITH FEWER THAN THREE EMPLOYEES MAY
VOLUNTARILY COME UNDER THE ACT.
PL
EASE TYPE OR PRINT:
SECTION 1: BUSINESS INFORMATION
NAME
OF BUSINESS: _______________________________________________________________
AD
DRESS OF BUSINESS: ____________________________________________________________
CI
TY / COUNTY: _____________________________STATE: ____________ZIP:________________
MAI
LING ADDRESS IF DIFFERENT FROM ABOVE:_____________________________________
CI
TY / COUNTY: _____________________________STATE: ____________ZIP: ________________
FEDE
RAL ID#:__________________________OR SOCIAL SECURITY #:_____________________
NA
ME AND TITLE OF PERSON COMPLETING THIS FORM:______________________________
P
LEASE GIVE A BRIEF DESCRIPTION OF BUSINESS ACTIVITY:____________________________
_
_____________________________________________________________________________________
PHONE # OF BUSINESS:________________________CONTACT PHONE #:______________________
E
-MAIL ADDRESS:_____________________________________________FAX#:__________________
I
F YOUR BUSINESS ADDRESS IS THE SAME AS HOME ADDRESS, PLEASE ANSWER THE
FOLLOWING:
P
LEASE CIRCLE ANSWER:
1. DOES THE AREA OF HOME USED EXCEED THE EQUIVALENT OF ONE QUARTER
OF
ONE FLOOR? YES NO
2. ARE EXTERIOR ALTERATIONS TO HOME REQUIRED? YES NO
3. DO CLIENTS OR EMPLOYEES COME ONTO PREMISES? YES NO
4. ARE COMMODITIES STORED OR SOLD THAT ARE NOT MADE ON PREMISES? YES NO
5. WILL THERE BE ANY BUSINESS SIGNAGE ON PREMISES? YE
S
NO
6. HOW MANY MOTOR VEHICLES USED IN YOUR BUSINESS WILL BE PARKED ON THE
PREMISES? 1 2 3 4 5 OR MORE
7. WITH WHOM DO YOU INTEND TO DO BUSINESS? (CONSUMER, OTHER BUSINESSES,
ETC,)_________________________________________________________________________
SECTION 2: CONTRACTOR INFORMATION
DO YOU HAVE A STATE A, B, OR C LICENSE? YES NO
STATE CONTRACTOR’S #:_________________________EXP DATE:_________________________
.
THE STATE OF VIRGINIA REQUIRES ALL CONTRACTORS TO OBTAIN A STATE
CONTRACTORS LICENSE IF THE CONTRACTOR BIDS $ 1,000.00 OR MORE ON ANY ONE
JOB. IT IS THE RESPONSIBILITY OF THE GENERAL CONTRACTOR TO HIRE ONLY
PROPERTY LICENSED SUBCONTRACTORS.
EFFECTIVE ON JANUARY 1, 1998, THE GENERAL ASSEMBLY ENACTED LEGISLATION
REQUIRING ALL CONTRACTORS TO CERTIFY COMPLIANCE WITH SECTION 65.2-801
OF THE WORKERS’ COMPENSATION ACT. ***SEE 'CONTRACTORS ONLY' NOTE
BELOW.***
IF YOU ARE NOT FROM POWHATAN, WHERE IS YOUR PRINCIPAL OFFICE LOCATED?
SECTION 3: FREEDOM OF INFORMATION
IF YOU DO NOT WANT YOUR NAME, ADDRESS, OR PHONE NUMBER MADE AVAILABLE TO
THE GENERAL PUBLIC, PLEASE CHECK HERE______________.
****************************FOR OFFICE USE ONLY*************************
SECTION 4: ZONING/BUILDING INSPECTIONS REVIEW
TAX MAP #:______________________________ZONING:_____________________________________
ZONING APPROVAL FOR ABOVE BUSINESS? YES
NO
SIGNATURE OF ZONING
ADMINISTRATION___________________________________________DATE___________________
RECOMMENDATIONS_________________________________________________________________
______________________________________________________________________________________
BUILDING A
PPROVAL FOR ABOVE BUSINESS? YES NO
SIGNATURE OF
BUILDING OFFICIAL__________________________________________DATE___________________
IF YOU HAVE ANY QUESTION, PLEASE CALL (804) 598-5616. IF APPLYING BY MAIL, PLEASE
MAKE CHECK PAYABLE TO THE TREASURER OF POWHATAN COUNTY AND RETURN
WITH ALL NECESSARY FORMS TO:
COMMISSIONER OF THE REVENUE
3834 OLD BUCKINGHAM ROAD SUITE C
POWHATAN VIRGINIA 23139
****************CONTRACTORS ONLY*********************
***EFFECTIVE JANUARY 2017, THE VIRGINIA WORKERS' COMPENSATION
COMMISSION WILL BE REQUIRING ALL CONTRACTORS TO FILE FORM 61A ONLINE.
THIS PROCESS MUST BE DONE PRIOR TO RECEIVING A COUNTY BUSINESS
LICENSE. ***NO BUSINESS LICENSE WILL BE ISSUED WITHOUT THE
CERTIFICAITON LETTER ISSUED FROM THE VIRGINIA WORKERS' COMPENSATION
COMMISSION.
GO TO WWW.WORKCOMP.VIRGINIA.GOV FOR FURTHER INFORMATION.