Business Name: _______________________________________________________________________________
Applicant Name: _______________________________________________________________________________
Applicant Phone: ________________________________ Applicant Email: _________________________________
Property Owner/Authorized Agent:__________________________________________________________________
Owner/Agent Phone: _____________________________ Owner/Agent Email: ______________________________
Property Address/Location: _______________________________________________________________________
Date(s) of Setup:_______________________________________________________________________________
I, as the above-noted property owner/authorized agent, agree to allow the above-noted applicant and business to
operate as a peddler on the above-noted property at the above-noted date(s).
Property Owner/Authorized Agent Signature Date
NOTES AND INSTRUCTION FOR APPLICANTS: Attach to this application a completed Town of Smithfield business
license application, and meals tax submission (if applicable). By signing below, you certify that you are aware of and
will abide by the following:
(1) I will not setup in a public right-of-way (ROW), and will avoid setting up within twenty-five feet (25’) of the same.
(2) I will pay the fees affiliated with this application- fifty dollars ($50) per day of operation, or five-hundred dollars
($500) a year, if the food truck will operate on the same premises for more than ten (10) days each fiscal year.
(3) If I relocate to a property where I do not possess a peddler’s license, I will submit a new application and/or fee.
(4) Before commencing operations, I will contact the Virginia Department of Health at 1-(757)-357-4177.
(5) All attachments to this application are true and inclusive of all details of the proposed operation(s) at the
property/properties in question.
Applicant Signature Date
TOWN STAFF ONLY
☐ Approved ☐ Denied
Town Staff Signature (for Ellen Minga, Town Treasurer) Date
2020-06-26 Application Version
TOWN OF SMITHFIELD
310 Institute Street, PO Box 246, Smithfield, VA 23431
Tel: 1-(757) 365-4200 Fax: 1-(757) 357-9933
PEDDLER’S LICENSE APPLICATION