Business License/Registration#_____________________ Zoned________________ 28874 Illinois Rt. 120 Fax: (815)385-8206 Lakemoor, Illinois 60051 Tel: (815)385-1117 Email: [email protected] Webpage: www.lakemoor.net

Business Phone: __________________________________________ Business Fax: Email:

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Business License Application

Business Information Name of Business: __________________________________________________________________________________________________________

Type of Business: ___________________________________________________________________________________________________________

Address of Business: ____________________________________________________

Lakemoor, Illinois 60051

Business Owner’s Full Name: ___________________________________________________ Phone:____________________________________

Address: _________________________________________________ City: _____________________________ State: ___________________________

Driver’s License Number:______________________________________________ State Issued: ____ Date of Birth___________________

State Tax ID Number: ____________________________________

Federal Tax ID Number: ________________________________

How long have you owned your business: ______________________

Please describe the nature of operations in detail:_________________________________________________________________________

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Will any flammable/hazardous material be used or stored? [ ] Yes [ ] No

If yes, please explain_________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________ Number of Full-Time Employees____

If restaurant, seating capacity____

Number of Part-Time Employees____

Square Footage______

Number of Rooms_____

Hours and days of Operations:_______________________________________________________________________________________________

__________________________________________________________________________________________________________________________________ Please Check One: If Incorporated:

_____Proprietorship ____Partnership _____Corporation ____Non-Profit Entity

State of Incorporation: ______________________ Date of Incorporation: ____________________________

Name & Address of registered agent: _____________________________________________________________

________________________________________________________________________________________________________

BUILDING PERTMITS MUST BE SECURED PROIR TO ANY WORK BEING DONE ON THE PREMISES

I/We understand the issuance of this license/registration is conditional upon compliance with all the Village of Lakemoor Ordinances, State and Federal Law and the results of any inspections required by ordinance at this time and further inspections while this license is in force. Some businesses are required to obtain a Conditional Use Permit or the business may not be permitted in the zoning district. I have read this application and answered all questions fully. The Information I/We have submitted in this application is complete and truthful to the best of our/our Knowledge. Signature of Applicant: _______________________________________________________________ Date:___________________________ Signature of Applicant: _______________________________________________________________Date:____________________________ Office Use Only Approved by:

Zoning Reviewed By:________________________________________ _____/_____/_____

Lakemoor Building Department ________ _____/_____/_____

_________________Fire Department ________ _____/_____/_____

Lakemoor Police Department ________ _____/_____/_____

_________________________________ ________ _____/_____/_____

Comments: _____________________________________________________________________________________________________________________

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_____________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________

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Business License/Registration #______________

28874 Illinois Rt. 120 Fax: (815)385-8206 Lakemoor, Illinois 60051 Tel: (815)385-1117 Email: [email protected] Webpage: www.lakemoor.net

Business Phone: _________________________________ Business Fax:

_______________________________

All information is confidential and for use only by the Lakemoor Police and area Fire Departments

EMERGENCY CONTACT INFORMATION Business Information

Name of Business: __________________________________________________________________________________________________________

Type of Business: ___________________________________________________________________________________________________________

Address of Business: ____________________________________________________

Lakemoor, Illinois 60051

Business Owner’s Full Name: ___________________________________________________ Phone:_________________________________

Address: _________________________________________________ City: _____________________________ State: _________________________

Key-holder Information

Name: _________________________________________________________ Phone: __________________________________ Type: ________________

Address: _______________________________________________________ Phone: __________________________________ Type: ________________

City: __________________________________________________________ State: _____________________________ Zip:_________________________

Name: _________________________________________________________ Phone: __________________________________ Type: ________________

Address: _______________________________________________________ Phone: __________________________________ Type: ________________

City: __________________________________________________________ State: _____________________________ Zip:_________________________

Other Emergency Contacts Name: _________________________________________________________ Phone: __________________________________ Type: ________________

Address: _______________________________________________________ Phone: __________________________________ Type: ________________

City: __________________________________________________________ State: _____________________________ Zip:_________________________

Name of Business: _______________________________________________________________________________________________________

Are you the Building Owner

_____Yes

If No--------Building Owner Information

_____No

Name: _________________________________________________________ Phone: __________________________________ Type: ________________

Address: _______________________________________________________ Phone: __________________________________ Type: ________________

City: __________________________________________________________ State: _____________________________ Zip:_________________________

Alarm Systems

Fire Protection

Smoke Detectors ______

Sprinkler System ______

Heat Detectors ______

Complete System _____

Alarm Company ____________________________________

Address: ____________________________________________

City, State, Zip: _____________________________________

Phone# _____________________________________________

Knox Box ________Yes

________No

Security Protection

Burglary _____

Complete System ______

Hold-up _____

Alarm Company ____________________________________

Address: _____________________________________________

City, State, Zip: _____________________________________

Phone# _____________________________________________

Insurance Information

Company: __________________________________________________ Agent’s Name: ____________________________________________________ Agent’s Address: __________________________________________

Agent’s Phone: ___________________________________________________

City, State, Zip: ___________________________________________________________________________________________________________________ Comments: ______________________________________________________________________________________________________________________

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