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2. Applicant's First Name
3. Applicant's Last Name
5. Commence Date
7. Business Address
9. City
10. State
11. Zip Code
13. Phone Number
14. Business Fax Number
16. Applicant's Email Address
18. Products/ Services
    Please indicate what products will be sold or what services will be rendered.
20. Please indicate whether this is a NEW or EXISTING business.*

    1. NEW Business
    2. EXISTING Business

    If this is a NEW business, please provide a Certificate of Use or Occupancy issued by the Village of Palmetto Bay's Building & Permitting Division. If this is an EXISTING business, please provide the Certificate of Use or Occupancy issued by Miami-Dade County.
22. Name of Business Owner:
24. Social Security Number or EIN:
25. Driver's License No.
27. Business Owner's Mailing Address
29. City
30. State
31. Zip Code
33. Business Owner's Phone Number
34. Business Owner's Email Address
36. Business Type
    Please submit the corporate documents showing the Federal Identification Number and/or the Registration of Corporation and/or Fictitious name. Please provide proof of approved sanitation services, if applicable.
38. Corporate Document Upload
39. Corporate Document Upload
41. If this business is a proprietorship, please provide the name of the proprietor:
43. If this business is a partnership, please provide the names of the partners:
45. If this business is a corporation, please provide the names of the officers and their titles in the space provided below:
47. Will this business...

    Please check all that apply.

    1. Be a professional association?
    2. Join an existing office?
    3. Have door-to-door service?
    4. Operate from a home?
    5. Require state licensing?
    6. Be licensing fee exempt?

    1. Serve liquor?
    2. Serve food?
    3. Sell tobacco products?
    4. Have day or adult care services?
    5. Deal with hazardous materials?
49. Describe the work below:
51. What is the gross floor area of the business facility (in square feet)?
52. What is the total number of parking spaces exclusively for this use?
    Identify the number of general spaces, handicap spaces and stroller permit spaces.
54. What is the number of employees, including owners and management?
55. What is the number of units?
57. What is the total number of coin-operated machines at location?
    (e.g. cigarette, soda, washer, dryer, etc.) Enter N/A if not applicable.
59. Public Records Disclosure

    All information provided by the taxpayer will become part of the public records except the SSN, which is protected by the confidentiality law of the State of Florida. If you claim exemption under F.S. 119 for another reason, please indicate in writing and attach to this application.

61. Business Tax License Application Affidavit
    Please upload the Village of Palmetto Bay Business Tax License Affidavit and submit with your application. The form may be downloaded from the Village of Palmetto Bay website.
Leave This Blank:


63. 1. Receive an email copy of this form.
64. Email address

    This field is not part of the form submission.

65. Submit Submit and Print

* indicates a required field