Check One: 
                                                                                                      New - $50 Fee 
 Data provided to the City of North Pole relative to Sales Tax is confidential except as may be    
 required for the enforcement of Section 4.08 of the North Pole Code of Ordinances.                   Renewal- $50  
 
                                                                                                     Acct. #            
                                          City of North Pole 
                                          125 Snowman Lane 
                                     North Pole, Alaska 99705 
                                          Tel: (907) 488-2281 
                                          Fax: (907) 488-3002 
 
                           BUSINESS LICENSE APPLICATION 

 Date Business Started:                                                             Today’s Date:                         
 Name of Business:                                                                  AK Business License:                  
 Mailing Address:                                                                                                         
                    Street                               City                                         State      Zip 
 
 Business Address:                                                                                                        
                    Street                               City                                         State      Zip 
 
 Business Phone:                                          Fax Phone:                                                      
 
  Email: _________________________________________ 
 Business Location: Fairbanks       North Pole         Borough/Outside Cities                           
 Type(s) of Sales:  Retail          Wholesale          Rental                                  Service     Other   

                                                 Specify 
 
 Indicate nature of goods sold or rented                                                                                  
                   Separate application and certificate required for each location. 
 Did you buy the above business?     Yes   No   

 If yes, name and address of Seller                                                                                       
 Type of Ownership:  Individual     Partnership        Corporation                                 Other    

 If “Other”, please explain                                                                                               
               All businesses must complete owner information section on back of this form 
 Do you currently conduct another business in the City of North Pole?                           Yes   No   

 If yes, give name and address                                                                                            
 
 Did you formerly conduct another business in the City of North Pole?                           Yes   No   

 If yes, give name and address                                                                                            
 
                                             IMPORTANT                               
                    THE INFORMATION ON ALL SIDES MUST BE COMPLETED 

 Revised 12/10 

                                             OWNER INFORMATION 
 
 For a Sole Proprietor or Partnership, this information must be completed for all legal owners. For a Corporation, this 
 information must be completed for all Corporate Officers (i.e. President, Vice President, Secretary and Treasurer). Social 
 Security number is optional. 
 
 1.                                                                                                                                    
 Name                                        Title            Social Security Number                                 Telephone Number 

 Home Address                                                 Mailing Address                        
 2.                                                                                                                                    
 Name                                        Title            Social Security Number                                 Telephone Number 

 Home Address                                                 Mailing Address                        
 3.                                                                                                                                    
 Name                                        Title            Social Security Number                                 Telephone Number 

 Home Address                                                 Mailing Address                        
 4.                                                                                                                                    
 Name                                        Title            Social Security Number                                 Telephone Number 

 Home Address                                                 Mailing Address                        
 
               INDIVIDUAL RESPONSIBLE FOR SALES TAX INFORMATION 
                           (To be filled out if you will be collecting and submitting sales   tax). 

 (1) The individual responsible for the records and sales made by the business and such other books or accounts as may be 
     necessary to determine the amount of tax the business must pay to the City (owner, partner, manager, bookkeeper, etc.) 
     Social Security number is optional. 
 
 Name                                        Title                     Social Security Number                        Telephone Number 

 Home Address                                                          Mailing Address         
 
 (2) The individual who calculates, holds for the benefit of the City, and transmits to the City the amount of tax collected by 
     the business each month (bookkeeper, manager, owner, etc.)  Social Security number is optional. 
 
 Name                                        Title                     Social Security Number                        Telephone Number 

 Home Address                                                          Mailing Address         
 
 (3) The individual who will file the tax returns for the business with the City each month (bookkeeper, manager, owner, etc.) 
     Social Security number is optional. 
 
 Name                                        Title                     Social Security Number                        Telephone Number 

 Home Address                                                          Mailing Address         
 
 I HEREBY CERTIFY that the statements made herein have been examined by me, and are, to the best of my knowledge and 
 belief true and complete. 
                                  Name                                                                                                 
                                                            (Must be signed by Owner, Partner, or Corporate Officer) 
                                  Title                                                                                                

 Revised 12/10 

                                                                  North Pole Fire Department 
                                                                       Pre-Fire Questionnaire 
                                                            (Only businesses located in the City of North Pole) 
  The purpose of this questionnaire is to help us help you during an emergency. Please fill this form out as completely as 
  possible. Please contact the Fire Department at 488-0444 if you need any assistance to complete this form. Let us know 
  immediately if any of this information changes so we can update our records.  Thank you for your assistance. 
                                                                                                                                           
  Business Name                                                                              Phone                    FAX 

  Address (physical location)                                                                        City                       State 
                                                                                                                                           
               Emergency Contact Information                                                  Fire Protection Systems Present and 
                                                                                                             Working 
  Primary Contact                                                              
                                                            ( )                              Battery Powered Smoke Detectors 
  Name                                                      Phone              
   
                                                                                             110v Smoke Detectors 
                                                            ( )             
  Address                                                   Cell Phone         
                                                                                             Sprinkler System 
                                                                               
  City                                                      State      Zip                   Standpipe 
  Secondary Contact                                                            
                                                            (  )                             Fire Suppression System 
  Name                                                      Phone              
   
                                                                                             Other                                       
                                                            ( )             
  Address                                                   Cell Phone         
                                                                                                                                        
  City                                                      State      Zip 
                                                                                                                                       _ 
                                                                                                                                           
          Hazards Specific to Type of Business                                                     Type of Building Construction 
                                                                               
      Mixed commercial/residential occupancy                                                Standard Wood Frame (Protected) 
      Firearms, ammunition, explosives,                                       
       etc… Indicate below what type and                                                     Standard Wood Frame (Unprotected) 
       amount.                                                                 
      Hazardous Materials stored on premises                                                Fire Resistive 
               (Please include copy of MSDS for each)                          
      Equipment generating heat, sparks or flame.                                           Ordinary construction 
       Please list                                                             
                                                                                             Non-combustible 
      Activities in which injuries are likely to occur.                       
                                                                                             Light Weight 
      Confined space activities likely.                                       
      Special rescue situations that might occur                                            Heavy Timber 
                                                                                                                                           
  What do you think the Fire Department should know about your business?                                                               

 Revised 12/10 

  Please sketch the floor plan of your business. Please include accurate dimensions, location of hazardous materials, or other 
  hazards, egress routes, and fire protection systems. If there have been changes since the last application please note changes 
  to the floor plan. This information will be only be used for training and response purposes. If security is a concern please 
 
  contact Chief Geoff Coon at 488-8868.  Thank you. 
 
 Revised 12/10