FOR OFFICIAL USE City of Las Vegas Receipt #: ID #: 1700 N ...
[Pages:1]FOR OFFICIAL USE Receipt #: ________________ ID #: _________________
Date: _____________________ Issued: ______________
City of Las Vegas
1700 N. Grand Avenue Las Vegas, NM 87701
Business Registration/License Application
(505) 454-1401 FAX: (505) 425-7335
Check One: New Business
Renewal
New Location
Date Closed _________________________
CHECK ONE: Business Name: ______________________________________________________________________________________
NEW CERTIFICATE 2017 STICKER ONLY
DBA: _____________________________________________________________________ Type of Business: __________________________________________________
Location Address: ______________________________________________________________________________________________________________ ________________ Street
Mailing Address: _________________________________________________________________________________________________________________________________
Street
City
State
ZIP
Business Phone: (_______ __ )______________________________________ Other Phone: (________ _)________________________________________
Email Address: ________________________________________________________
Type of Ownership:
Sole Proprietor
Partnership
Corp.
LLC
Non-Profit
Home Occupation:
Yes
No
Insurance Carrier: ________________________________________________________________________
Contractor:
Yes
No Lic. #: ________________ Exp. Date: _________________ License Type(s): ______________________________
(If Yes, Include a copy of State of New Mexico Construction Verification Card)
If Applicable:
Food Service?Will food be prepared or served? Yes
No (If Yes, NM Environment Dept. must approve before Registration is Issued)
Department of Health License #________________________________________________ ( Dept. of Health License required before Registration is issued)
NM Tax ID#: ______ ______ - ______ ______ ______ ______ ______ ______ - ______ ______ - ______
(NM CRS Number Required before City Business Registration is Issued)
FEES:
Business Registration:
$35.00 Standard Registration
Will you be placing a new sign:
Yes
No
If Yes, you will need a sign permit. Contact Building Inspector.
Additional Fees ? If Applicable: Other fees will be specified by City of Las Vegas according to Chapter 160, Business Ordinance.
Other Fees
$_____________ $25.00 Dance Halls, Auto Wrecker-Yards & Pawnbrokers
Other Fees
$______________ $25 for 1 Machine, 2-4 Machines $50, 5+ Machines $200
Late Penalty 10%
$______________
RENEWALS are Due on or before March 15, 2017.
Total
$______________
A 10% late penalty will be added after March 15, 2017.
_____________________________________________________________________________________________________________________________________________________________________
Owner/Applicant
Print Name
Signature
Date
Contact Person: ________________________________________________________________________________________________________________________________________________
Print Name
Date
Report required:
State Fire Marshal Approval 505-476-0080 1120 Paseo de Peralta P.O. Box 1269, Santa Fe, NM 87504
________________________________________________________
Construction Industries Division 505-827-7030
725 St. Michaels Drive
rld.state.nm.us
Santa Fe, NM 87505 (If Applicable)
__________________________________________________________ NM Environment Department (505) 454-2801 2538 Ridge Runner Road Las Vegas, NM 87701 (If Applicable)
_________________________________________________________ Zoning Approval (505) 454-1401, Ext. 3276 City of Las Vegas Community Development 1700 N. Grand Avenue, Las Vegas, NM 87701
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