Home Occupancy Application

Business Status

What would you like to do today:

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Business Name and Physical Location

Business Name or Trade Name	Burchill's Plumbing
Business Street Address (Physical location of the business cannot be a PO Box)	---
Mailing Address (Street name and number only)	---
Mailing Address City, State, & Zip Code	---
Business Phone Number	+19288485001
Alternate # (Emergency Phone Number)	---
Number of Employees	---
Please read through the list carefully and select the closest description of your business:	CONTRACTOR PLUMBING
Business Description (Please describe in detail the nature of the business)	---
Start of business date	2023-05-26
Locations where the business or applicant has operated during the last five (5) years	---
is the business location:	---
Nature of Ownership	---

Individual/ Sole Proprietor Owner Information (Eligibility Form)

Name (First and Last)	---
Title	---
Home street address (cannot be a PO Box)	---
Social Security Number (Last four (4) digits only)	---
Phone Number	---
*Check the box next to the document you are presenting to the Town, indicating lawful presence	---
Attach a copy of said document	---

Federal Tax ID or Social Security Number

Please provide your Federal ID or Social Security Number

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Transaction Privilege Tax (Sales Tax)

Transaction Privilege Tax (TPT) Number

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Professional Licenses

Upload File	---
Professional License or Permit Number & Description	---

Applicant Information (Must be completed by the person filling out this application)

Name (First and Last)	Robert Burchill
Home Address (No PO Boxes)	---
Phone number	---
Driver's License Number	---
Driver's License Expiration Date	---
Date of Birth	---
Social Security Number (Last four (4) digits only)	---
Email Address	[email protected]

Application Affidavit

Applicant Affidavit

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Conditional Home Occupation Permit

Will you need to apply for a Conditional Home Occupation permit?

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Prohibited Home Occupations Disclosure

I hereby declare that in the conduct of my Home Occupation at the above address, I will comply with the requirements pertaining to such occupations as set forth in the Prescott Valley Town Code mentioned above.

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Late Fee

Do they need a late fee?

No

Business License Number

Manually Enter Business License Number

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