Business License Application
Business License Status
| What would you like to do today: |
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| If you are are applying for a Prescott Valley local license, please select which Series you are applying for |
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Business Name and Physical Location
| Business name or Trade Name |
Davis Orthopaedics, LLC
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| Nature of Ownership |
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| Business Street Address (Physical location of the business (cannot be a PO Box) |
3237 N Windsong Dr, Prescott Valley AZ 86314-1222
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| is the business location: |
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| Mailing Address (street address or PO Box) |
854 Peppermint Way Prescott, AZ 86305
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| Business Phone Number |
+19287725320
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| Alternate # (Emergency Phone Number) |
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| Number of Employees |
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| Please choose the most applicable to your business: |
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| Please read carefully through the following list and choose the closest description of your business: |
MEDICAL HEALTH SERVICES
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| Business Description (Please describe in detail the nature of the business) |
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| Will your business be selling or serving alcohol? |
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| Start of business date |
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| Locations where the business or applicant has operated during the last 5 years: |
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Individual/ Sole Proprietor Owner Information (Eligibility Form)
| Name (First and Last) |
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| Title |
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| Home street address (cannot be a PO Box) |
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| Social Security Number (Last four (4) digits are accepted) |
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| Phone Number |
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| *Check the boxes next to the document you are presenting to the Town, indicating lawful presence |
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| Attach a copy of said document |
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Applicant Information (Must be completed by the person filling out this application)
| Name (First and Last) |
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| Home Address (No PO Boxes) |
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| Mailing Address |
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| Phone number |
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| Driver's License Number |
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| Driver's License Expiration Date |
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| Date of Birth |
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| Social Security Number (Last four (4) digits ONLY) |
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Federal Tax ID or Social Security Number
| Please enter your Federal Tax ID Number |
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Transaction Privilege Tax (TPT) - Sales Tax
| Please enter your Transaction Privilege Tax (TPT) Number |
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Professional Licenses
| Upload File |
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| Professional License or Permit Number & Description |
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Application Affidavit
Commercial Occupancy Permit
Commercial Occupancy Permit Application- Information
| What business is currently, or has most recently, occupied this business site? |
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| if applicable, what other businesses are located in this building or on this site? |
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| # of employees: |
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| Sq. Ft. of general floor area: |
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| Sq. Ft. of public floor area: |
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| # of parking spaces: |
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| Are the parking spaces paved? |
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| # of ADA Handicapped parking spaces: |
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| # of wall mounted business signs: |
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| # of free standing signs: |
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| Is this site landscaped? |
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| Is there outdoor lighting? If Yes, please specify how many. |
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| Do you intend to do any internal/external improvements to the building(s)? If Yes, please describe the type of improvements. (Ex: plumbing, sink, electrical, partitions, etc.) |
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Business Information Continued
| Normal operating schedule: please list operations hours/day & days/week (Ex. 8hrs/day, 7 days per week) |
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| Please check any of the following: Will this facility use __________. |
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| Do you or will you store chemicals on site in excess of normal household quantities? |
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| Do you or will you store or use petroleum or non-petroleum oils or greases in your business? |
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| Do you or will you discharge any wastewater (other than domestic wastes from toilets, showers, etc.) to the sewer system? |
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Prescott Valley Police Department Business Identification
| Alarm Company Name and Phone Number |
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| 1. Name and Phone Number of the Responsible Party |
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| 2. Name and Phone Number of the Responsible Party |
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Initial Application Review
(Internal) Late Fees
| Do they need a late fee? |
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