Application for Business Tax Receipt Certificate of Use
APPLICATION # RECEIVED BY: 100 East Boynton Beach Boulevard • Boynton Beach, FL 33435 • (561) 742-6360 • Fax (561) 742-6364 APPLICATION FOR BUSINESS CERTIFICATE OF USE CITY OF BOYNTON
BEACH DEVELOPMENT DEPARTMENT TYPE OF REQUEST □ NEW BUSINESS □ CHANGE OF OWNERSHIP □ ADDRESS/NAME CHANGE □ SHARING SPACE TYPE OF BUSINESS □ COMMERCIAL □ HOME-BASED □ CHILD DAY CARE/GROUP
HOME BUSINESS ADDRESS CITY/STATE/ZIP CORPORATION NAME D/B/A BUSINESS NAME EMAIL ADDRESS BUSINESS PHONE MAILING ADDRESS CITY/STATE/ZIP CONTACT NAME TITLE CONTACT PHONE FEDERAL TAX ID
(SSN/EIN) [Per FS 205.0535(5)] GROSS SQ. FT. DESCRIPTION OF PROPOSED BUSINESS/PROFESSION NUMBER OF EMPLOYEES INVENTORY VALUE (Merchant) NUMBER OF SEATS (Restaurant) NUMBER OF STATIONS
(Salon) NUMBER OF VEHICLES (Taxi/Limo) NUMBER OF MACHINES (Laundry) NUMBER OF ROOMS (Hotels, Motels, Assisted Living) PASSENGER CAPACITY (Charter Boats) HAS A CODE COMPLIANCE NOTICE
OF VIOLATION BEEN ISSUED? □ YES □ NO BUSINESS START DATE WILL YOU BE STORING/HANDLING ANY HAZARDOUS MATERIALS? □ YES □ NO IS THIS PROPERTY RENTED? □ YES □ NO DOES THE PROPOSED BUSINESS
CONSTITUTE A CHANGE OF USE? □ YES □ NO IS THIS A MOBILE VENDOR? □ YES □ NO IS THIS A CHARITABLE ORGANIZATION? □ Yes □ No IS THIS A LIVE-WORK BUSINESS? □ YES □ NO I certify that the above
information is true and correct to the best of my knowledge. I understand that the issuance of a business tax receipt does not eliminate or replace my obligation to comply with any city,
county, state or federal requirements related to the operation of this business. SIGNATURE DATE FOR OFFICE USE ONLY ZONING DISTRICT: PCN ADEQUATE PARKING? □ Yes □ No PREVIOUS BUSINESS
CLASSIFICATION: APPLICATION REVIEW APPROVALS INSPECTION APPROVALS DEVELOPMENT: Approved by Date FIRE: Approved by Date ZONING: Approved by Date BUILDING: Approved by Date (SEE BACK SIDE
FOR SUBMITTAL REQUIREMENTS AND HELPFUL CONTACT INFORMATION) S:\Development\Business Tax\Forms\BUSINESS CERTIFICATE OF USE APPLICATION.doc Last Updated: 6/16/2015
SUBMITTAL REQUIREMENTS ALL APPLICANTS MUST SUBMIT • Application for City of Boynton Beach Business Certificate of Use • Application for Palm Beach County Local Business Tax Receipt •
Copy of your lease and other licenses if applicable • Payment of fees due ($50 Certificate of Use and Business Tax Receipts) YOU MAY NEED TO SUBMIT • A printout of the Sunbiz online
records or copies of the business entity’s filing documents o If the business is a corporation, LLC or partnership • A printout of the Sunbiz online records or a copy of the Fictitious
Name Registration o If using a fictitious name or “DBA” • A copy of your certification or license o If your trade or profession is regulated by another agency • Materials Safety Data
Sheets (MSDS) for all hazardous materials to be used o If they will be stored at the business location HOME BASED BUSINESS APPLICANTS MUST ALSO SUBMIT • Home Occupation Conditions &
Affidavit of Agreement • Proof of residence (i.e., copy of utility bill for the residential address in the applicant’s name) COMMERCIAL BUSINESS APPLICANTS MUST ALSO SUBMIT • Closing
Statement or Bill of Sale o If you will be occupying property you recently purchased • Letter of Sharing from the current business at that location o If you will be sharing a space with
an active business HELPFUL CONTACT INFORMATION Employer Identification Number (EIN) – All businesses (except sole proprietorships with no employees) must register with the Internal Revenue
Service (www.irs.gov) for a federal tax identification number to be entered on the application. Palm Beach County Application for Business Tax Receipt – All applicants must include this
completed form at submittal (www.pbctax.com) (561) 355-2272. Corporation/LLC/Partnership filing documents – If you plan to do business as a corporation, LLC, or partnership, you must
first file with the Florida Department of State, Division of Corporations (www.sunbiz.org) (850) 245-6051. A printout of the online records or copies of the business entity’s filing
documents must be included. Fictitious Name Registration – If you plan to do business under a name that is neither 1) your full name nor 2) the name of your corporation, you must register
the name with the Florida Department of State, Division of Corporations (www.sunbiz.org) (850) 245-6058. State or County License/Registration/Certification – If the type of business
is regulated by a state or county agency, you must include documentation indicating compliance. • Department of Business and Professional Regulation (www.myfloridalicense.com) (850)
487-1395 o Most professions and contractors • Palm Beach County Contractors Certification Division (www.pbcgov.com/pzb/Contractors) (561) 233-5525 o Contractors without state certification
• Palm Beach County Health Department (www.pbchd.com) (561) 840-4500 o Child care facilities • Florida Department of Agriculture & Consumer Services (www.freshfromflorida.com) (800)
435-7352 o Food outlets, auto repair, travel agencies, telemarketers, health/dance studios • Florida Department of Health Health (www.floridahealth.gov) (850) 488-0595 o Health care
professionals, doctors, therapists • Florida Office of Financial Regulation (www.flofr.com) (850) 487-9687 o Banks, finance companies, securities brokers • Florida DBPR Division of Hotels
& Restaurants (www.myfloridalicense.com/dbpr/hr) (850) 487-1395 o Restaurants, mobile food operators, hotels, motels • Florida Agency for Health Care Administration (ahca.myflorida.com)
(888) 419-3456 o Health care facilities