CITY OF BLACK JACK COMMERCIAL BUSINESS LICENSE APPLICATION

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BUSINESS OWNER(S)
BUSINESS ADDRESS
IF YOU RENT A BOOTH AT A BARBER OR BEAUTY SHOP, YOU MUST ALSO COMPLETE THIS SECTION
ALARM COMPANY IF APPLICABLE
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I DECLARE UNDER PENALTY OF PERJURY THAT THE ABOVE APPLICATION IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. I CERTIFY THAT I HAVE OBTAINED ANY AND ALL CONSENTS, AUTHORIZATIONS, VARIANCES, WAIVERS, LICENSES, PERMITS AND APPROVALS FROM ANY FEDERAL, STATE, COUNTY, MUNICIPAL OR OTHER GOVERNMENTAL OR QUASI-GOVERNMENTAL AGENCY, DEPARTMENT, BOARD, COMMISSION BUREAU OR OTHER ENTITY OR THIRD PARTY NECESSARY FOR THE OPERATION OF MY BUSINESS IN COMPLIANCE WITH ALL APPLICABLE FEDERAL, STATE AND CITY LAWS AND REGULATIONS, AND THAT I WILL OPERATE MY BUSINESS IN ACCORDANCE THEREWITH. I FURTHER UNDERSTAND THAT ANY FALSE STATEMENTS MADE ABOVE ARE GROUNDS FOR DENIAL, SUSPENSION OR REVOCATION OF THE BUSINESS LICENSE.

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