Business License Application - General Business
265 Strand Street, St. Helens, OR 97051 | 503-397-6272 | www.sthelensoregon.gov
Business Name: ____________________________________
Address: __________________________________________
City/State/Zip: _____________________________________
Business Phone: ____________________________________
Business Email: _____________________________________
Mailing Address (If Different):
__________________________________________________
City/State/Zip: ______________________________________
No. of Rental Units (if applicable): _________ Residential
Yes No
_________ Commercial
Plumber License # _______________
Manuf. Dwell. Install # _______________
Other License # _____________________
Are you a non-profit:
Home-Based Business:
Located within City limits?
Temporary Business? (>60 Days)
State License Requi
red?
CCB #_______________
Is your business a secondhand or pawn store?
If yes, please fill out secondary application.
Yes
No
HOME-BASED BUSINESS ONLY - Please answer all of the following questions to see if a Home Occupation Permit
is required.
Is your business a garage sale?
Is your business for-profit production of produce or other food product grown on the premises? *
Is your business a hobby that does not result in payment to those who use your services?
If you answered YES to any question above, you do not need a Home Occupation Permit.
Does your business exhibit any evidence that it is taking place at your home? Yes No
Do you have any volunteers or employees who are not
considered principle residents of the home? Yes No
Do you have any exterior signs for the business on the home or property (excluding vehicle marketing)? Yes No
Will your business have any customers visiting your home? Yes No
Does your business include or require any outdoor storage of materials? Yes No
Will your business exceed 600 Sq. Ft. of an accessory structure (detached shed or garage)? Yes No
Will your business exceed 25% of the combined residence and accessory structure gross floor area? Yes No
If you answered NO to the above 7 questions, you do not need a Home Occupation Permit.
Yes No
Yes No
Yes No
Owner Name: ______________________________________
Owner Address: ____________________________________
Owner Phone: _____________________________________
Business Contact Name: ______________________________
Relation to Business: _________________________________
Please give a brief business description. What specific activity
are you conducting as your business?
Does your business have anything to do with selling Marijuana
as a Producer, Processor, Wholesaler, Retailer, or Medical
Canopy? If yes, please fill out the secondary MJ application.
Yes No
Yes N
o
Yes No
This application will be reviewed by the City's Building and Planning Departments. If further
information is needed, departments will contact you directly via phone and/or email with their
requests for more information. You may be asked to submit additional forms/applications
if necessary.
* If Yes, Please contact the Planning Department to discuss.
_________ FTE
No. of Employees (FTEs):
Date of Birth: _______________________
Emergency Conta
ct: _________________________________
_
___________________________________
Applicant Signa
ture
FOR OFFICE USE ONLY
Rece
ived By: _________________
___ Date: __________
Planning Dept Initials: _________
Building Dept Initials: __________
Waste Water Emailed: __________
Amount Paid: __
________
Date:
__________
Re
ceipt #: _______________
I hereby certify under penalty of perjury and false swearing that the information I have provided is true and correct.
_______________________
Date of Signature
Wastewater Environmental Survey - Please check all categories that apply to your business:
Does your business discharge anything other than domestic discharge?
Yes No
If Yes, explain what it is used for, where and how i
t is collected and disposed of:
Does your business have the potential to discharge wastewater containing any of the following materials?
Does your business have any floor drains, catch basins, sumps, sinks, or any other outlets
to the sanitary sewer in your manufacturing, production, or storage areas?
Yes No
Yes No
Does your business use or store any chemicals in quantities great than 25 gallons?
Is there a potential for runoff to enter a dra
in where materials or chemicals are handled/stored?
Yes No
If yes, explain:
Will your business have the potential to discharge wash water?
Yes No
If yes, explain:
Retail Manufacturing Dentistry/Orthodontics Fuel Dispensing
Auto Repair/Detailing/Car Wash Medical/Veterinari
an
Food Service
Machining/Metal Working
Acid Metallic Color Dyes Soaps/Detergents Alkaline
Amalgam/Mercury Toxic Organics Medicine/Rx Fats/Oils/Grease
Hot Water _____ Degrees None
What is the estimated water usage per day? __
______________________________________
*
In your application submission, please include a copy of your Oregon Business Registry for verification.
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