Revised 4/2017
CITY OF PORTAGE
HOTEL/MOTEL LICENSE APPLICATION
License Fee: $30.00
Receipt #:_____________
To the Clerk of the City of Portage: Application is hereby made for a license for a hotel/motel.
Individual Partnership Limited Liability Company
Corporation/Non-Profit Organization
If applying as individual/partnership: (Please print clearly)
Individual/Partner Name:__________________________ Address:_________________________
Name:__________________________ Address:_________________________
(List any additional partners on a separate sheet of paper)
If applying as corporation/LLC: (Please print clearly)
Name of Corporation/LLC_________________________________________________
Corporate Agent________________________________________________________
Address_______________________________________________________________
Trade/Business Name____________________________________________________
Business Address_______________________________________________________
Business Telephone_____________________________________________________
Local Agent (i.e., Store Manager)___________________________________________
Number of Rooms:____________
The undersigned agrees to comply with and be bound by all the laws, ordinances, rules, regulations and
penalties covering the business for which the license is applied. The license expires on June 30, ______.
Date:_________________________ _____________________________________
(Signature of Applicant)
For Office Use Only
Department
Approved
Denied
Signature/Date
Building Inspector
City Clerk
City Treasurer
Fire Chief
Police Chief
If denied, explain reason:_____________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
E-mail address____________________________
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