* Required          

DBA/Business Name/Owner Name
Corporation/LLC/LLP Name (If Different Than Above)
Business Address (Must be physical location, not a Post Office Box)	Verifying Address... Verified! Not recognized as a valid USPS address. Valid USPS address but is missing UNIT/STE #. Valid USPS address but UNIT/STE # is not recognized. PO Box is not allowed in business address. Verify Address Edit
Mail Address	Same as address above
	Verifying Address... Verified! Not recognized as a valid USPS address. Valid USPS address but is missing UNIT/STE #. Valid USPS address but UNIT/STE # is not recognized. PO Box is not allowed in business address. Verify Address Edit
Detailed Description of Business
Ownership Type	Corporation Ltd Liability Co Ltd Liability Partnership Ltd Partnership Partnership Sole Proprietorship Trust Unincorporated Association
Employee Count *
Estimated Gross Receipts in San Rafael For Full License Period *
Start Date in City of San Rafael (estimate if in the future)
Contact Information
Phone
Phone 2
Fax
Website
Email Address
CA Seller's Permit Number
FEIN
Standard Industrial Classification Code (SIC)	Type in at least 3 characters to search for SIC...
State License Information (Contractor, Medical, CAMTC, etc.)
State License Number
State License Type
State License Expire Date
State License Verification *
Additional Information
Reason for Application *	---Select---1. New Business Registration2. Relocated in San Rafael3. New Owner of Business4. Job in San Rafael5. Additional Location in San Rafael6. Other
Property Type (In-Town Businesses Only) *	---Select---1. Chair/Workstation Rental or Virtual Office2. Shared Space With An Existing Professional3. Exclusive Office Within A Suite4. Exclusive Suite/Location5. Home Occupation6. Not Applicable (Out-Of-Town)
Business Owner Ethnicity	---Select---African American/BlackAmerican Indian/Alaskan NativeAsian/Asian AmericanDecline to StateLatino/HispanicMultiple OwnersMulti-RacialNative Hawaiian/Pacific IslanderOther/Not DisplayedWhite
Are you a member of San Rafael Chamber?	Yes No
Do you plan on selling tobacco products? *	Yes No
Is your business a facility that is regulated by the NPDES Industrial Activities Stormwater General Permit for storm water discharges associated with industrial activities? *	Yes No
If Yes, provide the NPDES Industrial Activities Stormwater General Permit Identification # assigned by the State Water Resources Control Board.
Are you a commercial business within the City of San Rafael? *	Yes No
If Yes, did you fill out the Commercial Zoning Questionnaire on the Home page? (https://fs18.formsite.com/cityofsanrafael/form37/fill?id146)	Yes No
File Attachments (if required).  More Info
*Cumulative file size can not exceed 89MB. Please reduce the size of your files and try again.