Fillable Form 1.: BUSINESS TAX RECEIPT PROCEDURES NEW BUSINESS (City of Edgewater Florida)

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Form 1.: BUSINESS TAX RECEIPT PROCEDURES NEW BUSINESS (City of Edgewater Florida)

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CITY OF EDGEWATER
FINANCE DEPARTMENT
104 North Riverside Drive
P.O. Box 100
Edgewater, Florida 32132
doingbusiness@cityofedgewater.org
Phone: (386) 424-2400 FAX: (386) 424-2409
BUSINESS TAX RECEIPT
PROCEDURES
NEW BUSINESS & TRANSFER OF BUSINESS TAX RECEIPT (BTR)
1.
Complete application in its entirety. THE OPERATION OF A BUSINESS IS NOT PERMITTED UNTIL A
CITY BUSINESS TAX RECEIPT AND CERTIFICATE OF USE IS ISSUED. THIS PROCESS
NORMALLY TAKES APPROXIMATELY TWO (2) TO FOUR (4) WEEKS TO COMPLETE.
2.
Complete application in its entirety and return it to the City of Edgewater, Business Tax Official along with the
following documents:
•
The business owners (or representatives) Florida Driver’s License
•
Any required State License
•
Proof of Fictitious Name Registration and/or Corporate or LLC status.
3.
Business tax will be paid upon approval of application and issuance of Certificate of Use. Fee information may b
obtained from the Bus ness Tax Official at 386-424-2400 X 1305.
4.
A VOLUSIA COUNTY BTR IS REQUIRED FOR ALL BUSINESSES. Additional information may be
obtained by calling 423-3322.
5.
Restaurants/Lounges - The applicant must list the number of seats, number of bar stools, whether live
entertainment is provided and if alcohol is to be served. A copy of the businesses State License is required.
Note: Outdoor amplified entertainment may require a Special Activity Permit. Information can be obtained from
the Development Services Department.
6.
School/Day Care - The applicant must list the number of students and the number of staff. State
Registration/Certification is required prior to issuance of license.
7.
Automotive Service/Repair/Gas Station - The applicant must list the number of bays and the number of gas
pumps.
8.
Pool Hall/Billiards - he applicant must list the number of tables and the number of coin operated machines.
CONTRACTOR/SUBCONTRACTORDISCLOSURESTATEMENT
State law requires any subcontractor who receives compensation for services rendered carry liability insurance
and workers’ compensation insurance and/or workers’ compensation insurance exemption. You have applied for a
Business Tax Receipt (BTR)/Certificate of Use to work as a subcontractor in the City of Edgewater. By signing thi
affidavit you are stating that you have complied with these requirements. Failure to do so will result in your City of
Edgewater BTR/Certificate of Use being revoked. It is your responsibility to provide proof of liability insurance
and workers’ compensation insurance or worker’s compensation exempt affidavit to homeowners and/or
contractors when services are rendered.
PLEASE COMPLETE THE SUBCONTRACTOR AFFIDAVIT AND ATTACH IT TO THIS APPLICATION.
STATE LICENSE
Businesses requiring a State License, please attach a copy with the application.
FOLLOWING IS A LIST OF PHONE NUMBERS AND/OR WEBSITES THAT YOU MAY FIND HELPFUL
REGARDING YOUR BUSINESS TAX RECEIPT
City of Edgewater:
City Clerk’s Office - 424-2400 X 1102
Utilities Department - 424-2476
Fire/Rescue Services - 424-2445
Building Department - 424-2400 X 1514
Planning and Development Department - 424-2400 X 1502
Business Tax Department – 424-2400 X 1305
Volusia County:
Business Taxes 423-3322 - http://volusia.org/revenue/BTRinfo.htm
Public Health (Office of Environmental Health) 386-424-2065
State Agencies:
Not sure if your business is state regulated? http://csapp.800helpfla.com/CSPublicApp/AZGuide/AZGuideSearch.aspx
The following is a list of state agencies you may need to contact prior to opening your business:
To acquire a business name (DBA) Division of Fictitious Names - (850) 245-6058 www.sunbiz.org
To register a Corporation or LLC - Division of Corporations - Corporations (850) 245-6052- LLC (850) 245-6051
www.sunbiz.org
State Sales Tax Department of Revenue - 1160 North Williamson Blvd. Daytona Beach, FL 32114 - (386) 274-6600
www.myflorida.com/dor
Workers Comp Exemption - https://myfloridacfo.com/Division/wc/
Department of Agriculture and Consumer Services - (850) 488-3022 - www.doacs.state.fl.us/
Department of Business and Professional Regulation - (850) 487-1395 - www.myflorida.com/dbpr/
To sell motor vehicles - Regional Office - Highway Safety and Motor Vehicles - 1342-C S. Woodland Blvd. DeLand, FL
32720 - (386) 740-3821 - Highway Safety and Motor Vehicles
Sales Tax and Exemption - 800-352-3671 - Website: http://dor.myflorida.com/dor/taxes/sales_tax.html
Workers Compensation - 407-835-4406 – Website: http://www.myfloridacfo.com/wc
Employer ID Number (FEIN #) – 1-800-829-4933 -Website: http://www.irs.gov/businesses/index.html
CITY OF EDGEWATER
FINANCE DEPARTMENT
104 North Riverside Drive
P.O. Box 100
Edgewater, Florida 32132
doingbusiness@cityofedgewater.org
Phone: (386) 424-2400 FAX: (386) 424-2409
CERTIFICATE OF USE/BUSINESS
TAX RECEIPT
Date:
PLEASE READ INFORMATION PROVIDED
Per Chapter 11, Section 11-9(a) of the City of Edgewater Code of Ordinances, no person, firm or corporation shall
engage in or manage any business, profession, trade, amusement or industry in the city, without first making
application and having procured a Certificate of Use and a Business Tax Receipt for each location or premise.
Certificates of Use shall not be issued until a new business inspection is completed at the location or premise
and found to comply with all requirements of the code of the city and all applicable laws and regulations.
BUSINESS INFORMATION
Name Description
Phone Address
Mailing Address (if different)
Email Address
Local Emergency Contact Emergency Phone
Owner Name Applicant Name/Title
Type of Ownership
☐
Sole Proprietor
☐
☐
Partnership
□
State License No. (attach copy) Florida DL No. (attach copy)
Tax Exemption Number Veterans Claim Number
Federal Employee Identification Number (OR SS# if none issued) ______________
Do you wish to receive the City’s bi-weekly email newsletter geared towards Edgewater businesses: ☐YES ☐NO
PROPERTY OWNER INFORMATION (if different from business owner)
Name Phone
Mailing Address
CITY OF EDGEWATER
BUSINESS TAX RECEIPT
1
Has location been vacant for any period of time? ☐ YES ☐ NO; If yes, for how long?
Does Location Have an Alarm System: ☐ Yes ☐ No (alarm systems must be registered with the City)
Is there any proposed signage? ☐YES ☐ NO (sign permit required)
Are there any proposed alterations to the building/unit/site? ☐ YES ☐ NO (building permit required)
# of employees
# of paved
parking spaces
#of handicapped
parking spaces
Building/Unit
Square-feet
Merchants
Approximate inventory
in dollars:
School / Day Care
# Students
# of instructional rooms
Adult living facility
# of beds
Assembly
# of fixed seats
Auto Sales/Lease
# of vehicles for
sale/lease
Beauty/Barber Shops
# of chairs
Hotel/Motel/B&B
# of rooms
Restaurant/Bar/Lounge
# of seats
☐Live Entertainment
☐
Alcohol Served
Medical/Dental/Veterinary
# of exam rooms
Mini-Warehouse
# of offices
Pool Hall/Billiards
# of pool tables
# of coin operated
machines
Theaters
# of seats
# of vending
machines
Storage of hazardous materials
☐Yes ☐No (if yes, attach
MSDS)
Exemption for Fictitious Name Registration Requirement
I am exempt from the requirements of the Fictitious Name Act for my business for the
reason listed below: (Business Name)
☐I am using my full legal name (first and last) as my business name.
☐I am a Corporate Officer, part of a Limited Liability Corporation, or a Registered Partner in a Corporate
Partnership, my Corporate Name is my Business name, and my corporation is in Good Standing with the Florida Division
of Corporations.
☐I am Registered or Licensed with the Florida Department of Business & Professional Regulation.
☐I am Registered or Licensed with the Florida Department Health.
☐I am an Attorney licensed with the Florida Bar Association, forming a business for the practice of law.
☐Other
Attach proof of exempt status (i.e. Certificate of Incorporation, State License, etc.)
CITY OF EDGEWATER
BUSINESS TAX RECEIPT
2
COMMERCIAL/INDUSTRIAL QUESTIONNAIRE
Is Unit/Property on a septic system? ☐YES ☐ NO (If yes, Approval for existing septic system must be obtained through
the Volusia County Health Department prior to issuance of Certificate of Use.)
Will Industrial Waste Water be introduced into Sewer System? ☐YES ☐ NO
Type of Business: ☐ Industrial ☐Commercial ☐ Manufacturing ☐ Other
(a) Total number of employees: ☐ 0-5 ☐ 6-15 ☐ 16-50 ☐ 51-100 ☐ 101-300 ☐ 300+
What type of operating permits does your facility currently have?
□
State/Federal Hazardous Waste
☐
State/Federal Air Quality
☐
NPDES/ Storm water
☐
City of Edgewater Industrial
☐
Pretreatment Permit
☐
Other:
☐None
Are any wastes hauled off site: ☐Yes ☐No If yes, please indicate the type of waste:
☐
Acid/Alkalies
☐
Solvents
☐
Heavy Metal
☐
Oil & Grease
☐
Paint
☐
Radioactive
☐
Pesticides
☐
Other:
Anticipated start date of first discharge
Estimate the volume of water used at your facility: gallons per day
Estimated volume of wastewater discharged to the sanitary sewer: gallons per day
Where is Potable water used in the facility (check all that apply):
☐
Process/ Production
☐
Broiler feed water
☐
Non-contact cooling
☐
Sanitary
☐
Irrigation
☐
Fire Sprinkler
☐
Equipment Cleaning
☐
Other:
☐None
For each potable water line supplying this facility is there a backflow prevention device present?
Sanitary/ Process /Production / Equipment cleaning ☐YES ☐ NO
Irrigation ☐YES ☐ NO
Fire Sprinkler ☐YES ☐ NO
Does the facility treat wastewater prior to discharge ☐ YES ☐ NO
(b) If yes, please describe:
CITY OF EDGEWATER
BUSINESS TAX RECEIPT
3
______________________________________
___________________________________
__________________________________
ALL INSPECTIONS MUST BE COMPLETE AND THE PREMISES MUST BE FOUND IN COMPLIANCE
WITH ALL CITY AND/OR STATE CODES PRIOR TO THE ISSUANCE OF A CERTIFICATE OF USE AND
BUSINESS TAX RECEIPT. I UNDERSTAND THAT ANY INSPECTION TRIP MADE NECESSARY BY THE
RESPONSIBLE PARTY OR REPRESENTATIVE’S FAILURE TO APPEAR, SHALL IN ADDITION TO ANY
OTHER FEES, BE CHARGED AN ADDITIONAL PROCESSING FEE IN THE AMOUNT OF $15.00.
I DO HEREBY SWEAR OR AFFIRM THAT THE STATEMENTS MADE BY ME IN THE APPLICATION
ARE TRUE AND CORRECT. I UNDERSTAND THAT THE CERTIFICATE OF USE IS VALID ONLY FOR
USES FOR WHICH A VALID CERTIFICATE OF USE AND BUSINESS TAX RECIEPT HAS BEEN
OBTAINED (EXCEPT WHERE EXPRESSLY STATED). THE PERMIT/RECEIPT HOLDER IS
RESPONSIBLE FOR COMPLIANCE WITH ALL CITY, STATE AND FEDERAL REGULATIONS.
BUSINESS TAX RECEIPTS AND CERTIFICATES OF USE EXPIRE ON SEPTEMBER 30 OF EACH YEAR. IT
IS THE SOLE RESPONSIBILITY OF THE APPLICANT TO ENSURE LICENSE IS RENEWED.
APPLICANT’S SIGNATURE
STATE OF FLORIDA - COUNTY OF ______________________
Sworn to (or affirmed) and subscribed before me by means of ☐ physical presence or ☐ online notarization, this _____ day of
___________________________, 20 _____ , by _______________________________________________ . Personally Known OR
Produced Identification
(Signature of Notary Public - State of Florida) (Print, Type, or Stamp Commissioned Name of Notary Public)
FOR OFFICE USE ONLY
Industrial Pretreatment Permit Application Needed? ☐Yes ☐No
If yes, date sent to applicant
CITY OF EDGEWATER
BUSINESS TAX RECEIPT
4
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Form 1.: BUSINESS TAX RECEIPT PROCEDURES NEW BUSINESS (City of Edgewater Florida)

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Completed 22 January 2021

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