120 Malabar Rd SE Palm Bay, FL 32907-3009 (321)952-3419 http://www.palmbayflorida.org Fax: (321)733-3014 [email protected]

*APPLICATION FEE: $25.00 (Non-Refundable) *Receipt fees based on classification (Starting at $105.00)

COMMERCIAL BUSINESS TAX RECEIPT APPLICATION Please complete (print or type) the attached application. All blocks must be completed or have “N/A” (not applicable) written in. The Police and Fire Departments require three (3) emergency contacts, in the event of a fire or burglary and you are not available. If you are licensed in any way by the State of Florida or certified by Brevard County, a copy must be attached to the form when it is turned in. Be aware all businesses possessing certain machines or appliances (such as vending machines, cigarette machines, gas pumps, juke boxes, and game machines), whether in the employee’s lounge or available to the general public, must be included on the application. Please note that incomplete applications will not be processed until all requested information is provided. Failure to provide the requested information will result in additional time necessary to process your application. The application fee and receipt fee are required in order to process your application. The receipt fee will not be refunded once your application is submitted for processing unless the application is denied. Allow 10-14 working days to receive your Business Tax Receipt in the mail. When you receive your receipt from the City of Palm Bay, please be sure to contact the Brevard County Tax Collector’s Office, at 321-952-6325, to obtain information on your Brevard County Business Tax Receipt. You may not obtain the County Business Tax Receipt without first providing them with your City of Palm Bay Business Tax Receipt. Important Disclosure Social Security and/or Tax Id Numbers: are collected for the purpose of conducting a business.

APPICATION FOR COMMERCIAL BUSINESS TAX RECEIPT We would like to welcome you and your business to Palm Bay. As part of obtaining a Business Tax Receipt, a fire safety inspection is required by the Fire Department before you operate your business, even if your business is the same/similar as the previous occupant. A fire inspector will be contacting you to schedule an appointment for an inspection as quickly as possible, after you submit your application. To assist you in obtaining your Receipt, the following is a list of the most common fire code deficiencies noted by our fire inspectors: 1) The existing business location you have chosen may necessitate a change of occupancy. Just because there was a business in this location prior to your business there may be a different occupancy classification code for your business. If you have any doubts, come and meet with the Fire Inspection and Building Department personnel before you do anything else!! 2) Any vacant commercial unit that was for a different use, could possibly necessitate code required building modifications. In some cases a different occupancy classification could cause some significant Life Safety or Building code requirements. 3) Address or unit number(s) not posted on the building. The address must be conspicuously posted on the building; requirements are only three (3) inches high and three quarters (3/4) inch in width. We recommend six (6) inch high numbers. 4) Fire extinguisher(s) not provided, or improper rating. The minimum size and type of fire extinguisher required is a 2A;10bc dry chemical fire extinguisher. Specialty type extinguisher(s) may be required, depending upon the hazard of the contents of the business. 5) Circuit breakers not labeled and electrical panel boxes not accessible. All circuit breakers must be labeled to indicate what each circuit controls and a minimum of three (3) feet clearance must be provided in front of the panel. 6) Extension cords being used in place of permanent wiring. Only UL surge suppressors are permitted. It is against City ordinance to operate your business without a Business Tax Receipt. Under no circumstances should a business operate without having a Business Tax Receipt in their possession. It is important to have you business set up and any of the above listed items corrected prior to the inspector’s arrival. If any deficiencies are found, the fire inspector will work with you to correct these items. Sometimes code deficiency items are noted for items that may have been beyond the control of the previous inspection personnel and your cooperation is appreciated. The Inspections Bureau is interested in maintaining a fire safe environment for the business owners and customers. If we can be of assistance, please do not hesitate to contact us at 321-953-8929 between 8:00 am – 4:30 pm. **A fire inspection fee will be assessed. ** We wish you the best success in your new endeavor!

Mike Couture/Fire Marshal

Notice to Business Owners Regarding Sexual Offenders The CITY OF PALM BAY, BREVARD COUNTY, FLORIDA, adopted Ordinance 2005-76 on November 17, 2005. The ordinance provides, in pertinent part, as follows: It is unlawful for any business owner, manager, supervisor or employer to allow, direct, dispatch, or instruct a known sexual predator and/or sexual offender to enter into or upon any residence, including the curtilage thereof, any designated private or public school facilities or grounds, including school bus stops, or any day-care center, library, after-care center, park, playground, hospital, hospice facility, nursing home, adult daycare center, dwelling, domicile, or other place where children or vulnerable adults may reside or regularly congregate, to make deliveries or perform work. The ordinance places the responsibility on business owners, managers, supervisors or employers (hereafter “Employer”) to determine whether their employees are sexual predators or sexual offenders. Failure to make such determination can result in both a criminal conviction for violating the ordinance and the loss of the Business Tax Receipt. You are therefore required to determine if your employees, current and prospective, are sexual offenders or sexual predators and to prevent them from entering into the properties defined in the ordinance. A complete copy of Ordinance 2005-76 has been obtained from the Office of the City Clerk which is located at 120 Malabar Rd SE, Palm Bay, FL 32907.

Fats, Oils, & Grease Program 250 Osmosis Drive SE | Palm Bay, FL 32909 Phone: 321.952.3410 | Fax: 321.674.1852 [email protected] | www.pbud.org

NOTICE TO BUSINESSES THE CITY OF PALM BAY, BREVARD COUNTY, FLORIDA, adopted Ordinance 2013-15 on February 21, 2013. The ordinance provided revisions to the previous Sewer Use Ordinance and also established guidelines for the monitoring and regulation of fats, oils, and grease discharged into the City’s wastewater collection system. Your business may be subject to the requirements set forth in this Ordinance. See excerpt below: Section 201.240 GREASE, OIL, AND GROSS PARTICLE SEPARATORS INTERCEPTOR REGULATIONS. (A)

User Discharge Permit Required.

(1) All Food Service Establishments (FSE), whether new or existing , shall be required to obtain a user’s discharge permit from the City. (2) All industries requiring Gross Particle Separators, whether new or existing, shall be required to obtain a user discharge permit from the City. (3) All user discharge permit required establishments that change ownership must apply for a new user discharge permit within thirty (30) days of the change in ownership. You will need to apply for a permit if your business:  Serves food,  Operates a three compartment sink,  Uses an oil and water separator, or  Utilizes a sediment and water separator. On-line permits can be found on the Palm Bay Utilities Department’s web page [www.pbud.org] or directly at http://www.palmbayflorida.org/utilities/environment/fog.html. You may complete and submit applications online, or you may print the application and mail it to the above address. If you need assistance with the permit application please contact our office. A copy of Ordinance 2013-15 in its entirety may be obtained from the Office of the City Clerk located in City Hall at 120 Malabar Road, SE, Palm Bay, FL 32907 or online at http://www.pbfl.org/citycouncil/public/documents/2013_15_c.pdf. For additional information, please contact Palm Bay Utilities Department’s FOG Inspector at 321-9523400 ext. 7354 or via email at [email protected].

Notice to Commercial Businesses Vehicles for Hire Definition of Vehicle for Hire: Any motor vehicle as defined in Section 320.01(1)(a), Florida Statute, that may be hired for the purpose of conveying passengers at a rate of fare permitted by law. The markings on the vehicle for hire must include the name of the entity registered with the Florida Secretary of State. A copy of the type of business containing the Officers, Board of Directors, and the person who is authorized to bind the entity, is to be submitted along with the application. The minimum Insurance Requirement for a single Vehicle for Hire* is as follows:  Bodily Injury Liability (BIL) - $125,000 per person -$250,000 per occurrence  Property Damage Liability (PDL) - $50,000 *A business that has more than one driver/one vehicle would require commercial insurance and those limits would be in line with the type of conveyance used.

The Insurance Policy Number and Expiration Date must be submitted along with the application. A copy of the Business Tax receipt shall be carried in the vehicle at all times. A copy of the Business Tax Receipt application will be forwarded to the Palm Bay Police Department.

CHECKLIST o o o o o o

Completed/signed application Photo ID Form of Payment (check, money order, cash, credit card) Bill of Sale, if applicable Articles of Incorporation, if applicable State License, if applicable (i.e. Department of Professional Regulation, Florida Department of Agriculture and Consumer Services, ACHA) o County Competency Card, if applicable

Helpful Contact Information  Sunbiz.org- used for filing Fictitious Name or Incorporation in State of Florida  Department of Professional Regulation- www.myflorida.com or 850-4871395  Florida Department of Agriculture and Consumer Serviceswww.freshfromflorida.com or 800-435-7352  Division of Hotels and Restaurants www.myfloridalicense.com or 850-4871395  Agency for Healthcare Administration (ACHA) www.ahca.myflorida.com  Department of Alcohol, Tobacco and Firearms www.atf.gov  Brevard County Certificate of Competency [email protected] or 321-633-2058

CITY OF PALM BAY APPLICATION FOR COMMERCIAL BUSINESS TAX RECEIPT CHECK ONE:

CHECK ONE:

NEW CATEGORY CHANGE BUSINESS NAME: BUSINESS LOCATION:

NAME CHANGE

CHANGE OF LOCATION CHANGE OF OWNERSHIP

COMMERCIAL

___________________________________________________________________________________ ___________________________________________________________________________________

BUSINESS MAILING ADDRESS: ____________________________________________________________________________ BUSINESS TELEPHONE NUMBER: ________________________________ # OF EMPLOYEES: _________ NATURE OF BUSINESS: _______________________________________________ GROSS SQ FT: _____________ BUSINESS EMAIL: ______________________________________ BUSINESS WEBSITE: ________________________________ TYPE OF BUSINESS: INDIVIDUAL PARTNERSHIP CORPORATION NAME OF OWNER: __________________________________________________________________ DOB: _________________ OWNER’S ADDRESS: _______________________________________________________________________________________ TELEPHONE: ____________________ FAX: __________________ EMAIL: ______________________________ **SOC SEC #: _______________________ EIN: __________________ DL#: ___________________________________ **Social Security and/or Tax ID Numbers are collected for the purpose of conducting a business.

NAME: NAME: NAME:

THE FOLLOWING INFORMATION IS REQUIRED BY THE POLICE AND FIRE DEPARTMENTS FOR EMERGENCY USE AFTER HOURS AND ON WEEKENDS _____________________________________________ TELEPHONE: ______________________________ _____________________________________________ TELEPHONE: ______________________________ _____________________________________________ TELEPHONE: ______________________________

If you have a Burglar Alarm System, please complete: Name of Alarm Company: __________________________________________________ Telephone: ______________________________ If you are not the owner of the building, please list: Owner’s name: _______________________________________________________ Telephone: ____________________________ Owner’s address: ________________________________________________________________________________ STREET ADDRESS OR PO BOX, CITY, STATE, ZIP CODE

I hereby declare that the preceding statements are true and correct to the best of my knowledge and belief. I understand that violation of any Federal, State, or Local Ordinance is grounds for the City of Palm Bay to void the Receipt. By my signature, I acknowledge that I have been made aware that the issuance of a Business Tax Receipt does not constitute the only authorization required to conduct business in the City of Palm Bay.

Signature of Applicant: ______________________________ Date: _______________ Printed Name: ______________________________

APPLICANT MUST COMPLETE TO THIS LINE ONLY ZONING: FIRE: CODE: BUILDING: when applicable

Account #: Control #: OA: OT:

By: By: By: By:

_______________ _______________

___________ ___________

OL: OP:

__________________________________ __________________________________ __________________________________ __________________________________

Category Code: Category Name:

___________________ ___________________

________________ ________________ OR:

DATE: DATE: DATE: DATE:

____________________ ____________________ ____________________ ____________________

Category Code: Category Name:

APPROVED: APPROVED: APPROVED: APPROVED:

__________________ __________________

____________

Signature____________________

DENIED: DENIED: DENIED: DENIED:

This form is to accompany the record/document upon which is written the social security number of the individual whose name is shown below. A copy of this form is to be provided to or retained by the individual.

SOCIAL SECURITY NUMBER Statement of Purpose Pursuant to Florida Statutes, Section 119.071(5) (a) 2, the City of Palm Bay is required to provide to you in writing the purpose for collecting your social security number. It is being collected by the City for the following purpose/reason: Background Information/History Billing/Payments Business Occupation Verification Credit Screening Eligibility for Governmental Subsidy Identity Verification Benefit Processing Taxpayer Identification/Certification Training/Certification Vendor Verification Other: ___________________________ ACKNOWLEDGEMENT: I, ________________________________, hereby acknowledge receipt of a copy of this document on _________________________________, 20___. _______________________________ Signature

Welcome to the City of Palm Bay! The City of Palm Bay and the Palm Bay Police False Alarm Reduction Unit would like to extend a warm welcome to you as a new business owner in the City of Palm Bay and sincerely hope that your undertaking is extremely successful. The Palm Bay City Council adopted Alarm Ordinance, Chapter 117, in October, 2000, that requires all alarm-users operating an alarm system obtain a permit issued by the Alarm Administrator. The duration of the permit shall be one year from the date the initial permit is issued. The permit is renewed annually. Attached to this letter you will find a City of Palm Bay Alarm User Permit/Registration form. Please complete the form and return it along with a check or money order in the amount of twenty dollars ($20) made payable to the City of Palm Bay to the following address: False Alarm Reduction Unit Police Revenue Office 120 Malabar Rd., SE Palm Bay, FL 32907 Your Alarm User registration will be sent to you through the U.S. mail. It is the responsibility of the alarm owner/operator to contact its alarm monitoring company with their permit/registration number as it must be provided to police dispatch by the monitoring company when they request for police response to alarm activation. If you have any questions or need more information, feel free to contact me at 321-733-3024 or email: [email protected] Sincerely, Elaine Revis City of Palm Bay Palm Bay Police Department Police Revenue Coordinator

Instructions for Completion of Alarm User Permit/Registration Form Section A – To be completed by Residential alarm users only Alarm User Name: First and last name of the residential alarm user. List both spouses, if applicable. Alarm Location: Complete street address, including directional prefixes, where the alarm is located. Indicate the home, work and cell or pager (cell is preferable) numbers of the alarm user, as well as one email address where the alarm user can receive correspondence. If no email address is available, leave blank. Section B – To be completed by both Residential and Commercial alarm users. Section C - To be completed by Commercial alarm users only. First Line: Indicate the full legal corporate name of the business. If the business is a sole proprietorship or partnership, list the name of the owner or one partner. Second Line: List any trade names used by the business if different from the corporation name, owner or partner’s name. Alarm Location: Complete street address, including directional prefixes, where the alarm is located. Indicate the business phone number at the alarmed location. Owner or President: List the first and last name of the president, owner or person responsible on a corporate level for the alarm system at the alarm address. Indicate the home, work and cell or pager (cell is preferable) numbers of the business owner, president or partner, as well as one email address where this person can receive correspondence. If no email address is available, leave blank. Local Manager: List the first and last name, home, work and cell or pager (cell is preferable) numbers and email address for the local manager at the alarm site. Section D – To be completed by both Residential and Commercial alarm users Mailing Address: Indicate separate mailing address if different from the alarm location. Section E – To be completed by both Residential and Commercial alarm users Contact Information: Contacts are persons, who should be contacted in the event of an alarm, and who are willing and have agreed to receive notification of an alarm activation at any time, respond to the alarm site within (specify time limit), grant access to the alarm site and deactivate the alarm system if such becomes necessary. Two separate contact persons are required. Provide home, work and cell or pager (cell is preferable) numbers, as well as email addresses of contacts. Section F – To be completed by both Residential and Commercial alarm users Alarm Install/Service Company: List the name of the company that either installed or services your alarm system. Include the alarm company’s license number, contact person and the best phone number at which to reach this individual. Check your contract or contact your alarm company for the information. Section G – To be completed by both Residential and Commercial alarm users Alarm Monitoring Company: List the name, license number, contact person and phone number of the company that monitors your alarm system and requests public safety dispatch on your behalf. If same as install or service company, leave blank. Section H – To be completed by both Residential and Commercial alarm users Special Conditions: Indicate any unusual circumstances that should be considered when responding to an alarm at the permitted alarm address such as: handicapped person(s), guard dog on site, hazardous conditions/materials, security personnel, weapons, directions to alarm site, etc. Signature Line: A responsible residential alarm user or the president, owner, partner or local manager of a commercial alarm user must sign this form.

CITY Of PALM BAY

Permit/ Registration No.

ALARM USER PERMIT/REGISTRATION 120 Malabar Rd., SE, Palm Bay, Fl 32907 Tel. (321) 733-3024

___________ __

A NON-REFUNDABLE $20.00 PERMIT/REGISTRATION FEE MUST BE SUBMITTED WITH EACH PERMIT/REGISTRATION FORM. MAKE CHECK OR MONEY ORDER PAYABLE TO “CITY of PALM BAY” A.) Residential Alarm User Information: (Residential alarm users, please complete Sections A, B and D through H.) Alarm User Name: ______________________________ _____________________________________________ First Name

Last Name

Alarm Location: _________ ______ ______________________________________________ ______ ________ Street Number

Street Prefix

Street Name

Street Suffix Suite/Apt. No.

____________________________________ __________ ____________ _________________________________ City

State

(____)______________ Home Phone

(____)______________ Work Phone

Zip Code

Gate Code

(____)______________

_______________________________

Cell Phone or Pager

Email Address

B.) Residential and Commercial alarm users must complete: Type of Alarm (check all that apply):

Intrusion

Panic

Medical

Robbery

Audible

Fire/Smoke

C.) Commercial Alarm User Information: (Commercial alarm users, please complete Sections B through H.) ______________________________________________________________________________________________ Name of Corporation, Sole Proprietor or Partners

______________________________________________________________________________________________ Trade Name(s) Used by Business

Alarm Location: __________ _______ _____________________________________________ ______ _______ Street Number

Street Prefix

Street Name

Street Suffix Suite/Apt. No.

___________________________________________ _______ ____________ City

State

Zip Code

(____)______________________ Business Phone Number

Local Manager: _______________________________ ________________________________________ First Name

(____)_______________ Home Phone

(____)_______________ Work Phone

Last Name

(____)_______________ Cell Phone or Pager

____________________________ Email Address

D.) Mailing Address: (If different from Location of Alarm System) ______________________________________________________________________________________________ E.) Contact Information: (List two people, other than the owner, who can respond to an alarm activation.) 1st Contact Name: ________________________________ First Name

(____)_______________ Home Phone

(____)_______________ Work Phone

First Name

Home Phone

(____)_______________ Work Phone

Last Name

(____)_______________ Cell Phone or Pager

2nd Contact Name: ________________________________ (____)_______________

_____________________________________________ ____________________________ Email Address

_____________________________________________ Last Name

(____)_______________ Cell Phone or Pager

____________________________ Email Address

F.) Alarm Install/Service Company: ________________________________________ Lic. No.___________________ Contact Person: ________________________ Phone (____)__________________ G.) Alarm Monitoring Company: ___________________________________________ Lic. No.___________________ Contact Person: __________________________ Phone (___)_________________ H.) Special Conditions: (List hazardous conditions/materials, guard dogs, security personnel, weapons, directions to alarm site, etc.) _______________________________________________________________________________________________ I have read the completed application and know the same is true and correct and hereby agree that if a permit is issued, I will comply with all the provisions of the City of Palm Bay Code and with applicable State Laws. I accept responsibility for payment of all fines and fees that may result from the operation of the alarm system serving the above premise. I have read the information on Palm Bay’s False Alarm Reduction Program. Permit/registration of an alarm system is not intended to, nor will it, create a contract, duty or obligation, either expressed or implied, of response. Any and all liability and consequential damage resulting from the failure to respond to a notification is hereby disclaimed and governmental immunity as provided by law is retained. By permitting/registering an alarm system, the alarm user acknowledges that police response may be based on factors such as availability of police units, priority of calls, weather conditions, traffic conditions, emergency situations and staffing levels. FOR DEPARTMENT USE ONLY

Date: ___________ Signature: _____________________________________

http://www.palmbayflorida.org/police/public/falsealarm.html

CK#_________________________ MO#_________________________ EFT#________________________

120 Malabar Rd SE Palm Bay, FL 32907-3009 (321)952-3419

http://www.palmbayflorida.org [email protected] Fax: (321)733-3014

BUSINESS TAX RECEIPTS SCHEDULE OF FEES In July of each year, annual renewal notices will be sent to each business holding a current City of Palm Bay Business Tax Receipt. Failure to receive notice will not be considered a justifiable defense for nonpayment of the annual receipt fee or late payment fee. Business Tax Receipts must be renewed before October 1st of each year. Late Payment Fees Receipts not renewed by October 1st are delinquent and are subject to the following penalty schedule: Date Renewed Total Cost Oct 1—Oct 31 Nov 1—Nov 30 Dec 1—Dec 31 Jan 1—Sep 30

Annual Receipt Fee + 10% Annual Receipt Fee + 15% Annual Receipt Fee + 20% Annual Receipt Fee + 25%

Half Year Fee For each receipt obtained by a new business between April 1 st and September 14th of any year, one-half (1/2) of the fee for one (1) year shall be paid. A new business obtaining a receipt between September 15 th and September 30th may operate under the authority of its ‘next year’ (October 1 –September 30) receipt. Transfer Fee Transfers of Business Tax Receipts are accepted for a new ownership (with proof of sale) or change of business location (within city limits of Palm Bay). Cost: a) 10% of the annual receipt fee or b) $25.00 (whichever is less) Duplicate Receipt Fee A current receipt may be duplicated in the event of loss, theft, or defacement. Cost: $10.00 Refund of Fees No portion of any fee will be refunded, except if the fee is collected in error. No refunds will be made after the expiration of the receipt year for which it was issued.