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This receipt is in addition to and not in lieu of any license or receipt required by law or city ordinance and is
subject to regulations of zoning, health and any other lawful authority Section 17-17 of Palm Beach County
Ordinance No. 72-7.
For more information, call (561) 355-2264 or visit our website at www.pbctax.com.
Mail completed application to: Palm Beach County Tax Collector
Attn: Business Tax Department
P.O. Box 3715
West Palm Beach, FL 33402-3715
Visit www.pbctax.com/appointments to make an appointment at one of our
service centers to process your completed application.
APPLICATION REQUIREMENT GUIDE (CHECKLIST) **Please complete application on reverse side.**
COMPLETE APPLICATION (box #1 on reverse side)
ATTACH A COPY OF FICTITIOUS NAME REGISTRATION (if applicable): www.sunbiz.org
OBTAIN ZONING APPROVAL from the following (box #2 on reverse side):
Unincorporated Home Based Business - Form #103 must be completed.
Municipal/City Business Tax Receipt (If business is located within city limits, submit this application to the city for
zoning approval).
Unincorporated - Palm Beach County Zoning Approval (If business is located in unincorporated Palm Beach County)
submit this application to Palm Beach County Planning, Zoning & Building for approval [2300 N. Jog Rd. West Palm
Beach-Vista Center (561-233-5200)].
COPIES OF STATE OR COUNTY CERTIFICATIONS/LICENSE (if applicable):
Dept. of Business and Professional Regulation .........................................................(850) 487-1395
Palm Beach County Dept. of Health ............................................................................(561) 840-4500
State of Florida Dept. of Health ...................................................................................(850) 488-0595
Palm Beach County Construction Industry Licensing Board .....................................(561) 233-5525
State of Florida, Dept. of Agriculture and Consumer Services ..................................(800) 435-7352
Florida Division of Hotel & Restaurants ......................................................................(850) 487-1395
Florida Offi ce of Financial Regulation ......................................................................... (850) 410-9805
NOTE: Price quotes are only valid if received and posted in the Tax Collector’s Offi ce within the same month of quote.
Sec. 17-17 of PBC Ordinance No. 72-7.
No business tax receipt shall be issued until applicable county and
state laws are complied with including, but not limited to, building,
zoning, construction industry licensing, fi re control and health.
www.pbctax.com
Application Requirement Guide for Local Business Tax Receipt
Revised 9-24-2020
#1: BUSINESS INFORMATION (To be completed by applicant): **Instructions & checklist on reverse side**
Check Applicable Box: New Business Transfer of Address Transfer of Ownership Business Name Change
.noitacilppa siht htiw noitartsiger fo ypoc timbuS .eman suoititc if a fo noitartsiger seriuqer snoitaroproC fo noisiviD
Owner/Applicant Name: _________________________________________________________________________________________
Federal Employer ID #: ____________________________ **OR** Social Security #: __________________________________________
Business Address: ______________________________________City: ________________________ State: _____ ZIP: ____________
Applicant/Business Start Date at Location: ___________________ Business Phone Number: ____________________________________
Mailing Address (if different above): _____________________________City: ________________________ State: _____ ZIP: ____________
E-Mail address: ________________________________________________________________________________________________
Nature of Business: ___________________________________________ **OR** Profession: __________________________________
(Landscaper, Cleaning Service, etc.) (Doctor, Lawyer, etc.)
Maximum Number of: Employees: ___________ Machines: _____________ Rooms: ____________ Restaurant seating: ____________
Were you issued a Notice of Non-Compliance? _________ Yes _________ No
I certify, under penalty of law, that the above information is true and correct, and I understand that any false statements could result in penalties as provided by law.
Signature: ____________________________________________Title: ___________________________________________________
(Agent, Owner, Rep.)
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Sec. 17-17 of PBC Ordinance No. 72-7.
No business tax receipt shall be issued until applicable county and
state laws are complied with including, but not limited to, building,
re control and health.
www.pbctax.com
Application For Palm Beach County Local Business Tax Receipt
Revised 9-24-2020
PBCTC Form 65
Other ______________________________________
Existing PBC LBTR # (if applicable): __________________________________________________________________________________
Corporation/Business Name: ______________________________________________________________________________________
Fictitious/DBA/Trade Name: ______________________________________________________________________________________
#2: PLEASE NOTE: ZONING APPROVAL MUST BE COMPLETED PRIOR TO APPLICATION SUBMITTAL
Municipal/City Zoning Approval: __________________________________________________________ Title: _____________________
Additional Fees May Apply
Unincorporated Zoning Approval/Planning Zoning & Building Approval: _____________________________ Title: _____________________
PCN: __________________________________ePZB Application Number: __________________________ Date: ___________________
Control Number: ___________________________________ Resolution Number: _____________________________________________
Use pursuant to the PBC ULDC Article 4 supplementary use standards: _______________________________________________________
PZ&B - Check box if approval from department is required***
Regulator Signature required on line, when approval has been granted***
Zoning (U No.) _______________________________________ Fire Marshall ___________________________________
Compliance _________________________________________ Health Department _______________________________
Building ___________________________________________ Hotel & Restaurant _______________________________
NAICS Code _________________________________________ Prior Use of Bay/Bldg. ____________________________
Other______________________________________________
___________________________
FOR TCO OFFICE USE ONLY
LBTR#/Account #: ___________________________________ State/County License Cert #: ____________________________________
CSS / SCSS: _________________________ Date: ____________________ Field Service Approval: ______________________________
NAICS Code ________________________________________ TOTAL FEE DUE: $ _____________________ Receipt #: _______________