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 Fee 
                                                                                                   
                                                                                                  Acct# __________ 
                                                                                                                     
                                            City of North Pole 
                                            125 Snowman Lane 
                                            North Pole, Alaska 99705 
                                                 (907) 488-2281 
                                          
                                         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# _______________________ 
 
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 
 
(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 
 
 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 488-2232 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             
 ZIP 

              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 
                                                                            
 __________________________________________                               Standpipe 
 City                          State                    Zip
                                                                            
 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 amount.                                Standard Wood Frame (Unprotected) 
     Hazardous Materials stored on premises                                
           (Please include copy of MSDS for each)                         Fire Resistive 
 
      Equipment generating heat, sparks or flame.                           
      Please list______________________________                           Ordinary construction 
      ______________________________________                                
 
      Activities in which injuries are likely to occur.                   Non-combustible 
      ______________________________________                                
                                                             
      Confined space activities likely.                                    Light Weight 
 
      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 Buddy Lane at 488-2232.  Thank you. 

Revised 12/10