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2. 
3. TODAY'S DATE*
   TODAY'S DATE
4. DATE TO OPEN
   DATE TO OPEN
6. *APPLICATION FEE: $20.00 (Non-Refundable)

   *PLUS: Receipt Fees based on classification.

8. Filing this application for a City business tax receipt DOES NOT allow the applicant to operate or engage in any type of business until the issuance of a tax receipt to the applicant. Any person, firm or corporation who shall engage in any occupation, business or profession without obtaining a Business Tax Receipt shall be punished as provided by law.
10. SELECT ONE:*
    -- Select One --New Business Tax ReceiptTransfer OwnerRelocation within the City of West MelbourneRental Property
11. BUSINESS TYPE*
    -- Select One --Restaurant/TavernHome Based Business (no public traffic permitted to residence)Storage Unit/Private MailboxShort-Term Rental(rentals of less than one week are prohibited)Retail/MerchantOther
12. If "Other" Selected, Type Here
14. Commercial Location Square Ft of Unit
15. Apartment complex # of units
16. Hotel/Motel Number of Rooms
17. Vending/Amusement # of Machines
19. If your business of profession requires a State of Florida license, please provide a copy of all appropriate licenses or certificates, regulated by the State or the County.
21. ATTACHMENT
22. ADDITIONAL ATTACHMENT
24. Please include proof of your Entity or Fictitious Name Registration.
26. Business or Home Physical Address*
27. Unit/Suite #
29. Name of Business (dba)*
31. Business Mailing Address*
32. Unit/Suite #
34. Name of Property Owner*
36. Contact Person at the Business
37. Phone
39. Business Phone
40. Emergency Phone
42. Business Email Address
44. Business Web Address
46. Name of Business Owner
47. Business Owner Drivers License #
49. Number of Employees
50. Federal Tax ID or SS #*
52. Per Florida Statute 205.0535 (5), NO BUSINESS TAX RECEIPT SHALL BE ISSUED UNLESS THE FEDERAL EMPLOYER IDENTIFICATION NUMBER OR SOCIAL SECURITY NUMBER IS OBTAINED FROM THE PERSON TO BE TAXED.
54. Ownership Type
    (Sole Proprietor, S Corp, Corp, LLC, etc.)
56. Description of Business or Service to be provided (or attached letter to describe business activity)
58. I acknowledge that the issuance of this business tax receipt is contingent upon complying with the building and fire prevention requirements of the City. Inspections will be performed, and should deficiencies be found that are in conflict with the City Code, I understand that the city will not issue the business tax receipt until I (or the owner of the building, if leased) make the required corrections. I understand that should correction be necessary, I am not permitted to operate this business until those corrections have been completed and approved.
60. Certification: I certify that all the information contained herein is true and correct to the best of my knowledge and belief. If any portion is found to be false or misrepresented, such fact may be just cause for immediate revocation of any license issued to me. It is further understood that I must comply with the Code of Ordinances of the City of West Melbourne, Florida and failure to correct conditions that are in violation is punishable under the code.
62. I understand that upon issuance of the city business tax receipt, I may also need to make an application to Brevard County for a business tax receipt. I understand that if I engage in a business under a fictitious name, I must comply with the "FICTITIOUS NAME STATUTE", Section 865.09 and Florida State Statutes.
64. Signature of owner of business (or qualified corporate officer)*
65. TODAY'S DATE*
    TODAY'S DATE
67. Annual Fire Safety Inspection Fees : fees are established based on the square footage of the building and the list below and include one compliance re-inspection. Additional compliance inspections shall be charged as per section F of Resolution 2012-28.
68. Commercial Properties Only (See square footage below)
    
    * 0-2000 $25.00
    * 2001-10,000 $35.00
    * 10,001-50,000 $50.00
    * 50,001-100,000 $90.00
    * 100,001-250,000 $140.00
    * 250,001-500,000 $215.00
    * 500,001-1,000,000 $310.00
    * 1,000,001 and up $410.00
70. Mailing Address: 2240 Minton Road, West Melbourne, FL 32904 (321) 327-6614
Leave This Blank:


72. 1. Receive an email copy of this form.
73. Email address

    This field is not part of the form submission.

74. Submit Submit and Print

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