CITY USE ONLY 
Date Received: _____________ 
Date Issued: ________________ 
License No: _________________ 
Business License No: ____________ 
                                                                                                      
 Form 101.0.04.17 
                                                  
                                   GENERAL BUSINESS LICENSE 
                                                  
                                    **License Fee $20.00** 

Ownership:        Individual                    Partnership         Corporation 

                  Nonprofit (attach tax-exempt letter)       LLC                LLP 
 
Business Type:    Retail sales                      Home occupation        Wholesale 

                  Utility                           Construction           Leasing 

                  Financial Institution             Government             Hospitality  

                  Transportation                    Professional Services  Manufacturing 

CONTACT INFORMATION: 
Taxpayer Entity Name (Owner, Partnership, Corp): ___________________________________________________ 

Trade Name of Business (d/b/a): ____________________________________________________________________ 

Physical Address of Business: ______________________________________________________________________ 

Mailing Address, including Unit #: _________________________________________________________________ 

Business Phone: _________________________________________________________________________________     

Business Email Address: __________________________________________________________________________ 

Website: __________________________________________ 

Fully describe business operations: __________________________________________________________________    
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________

 7887 E. 60th Ave., Commerce City, CO 80022   Tel: 303-289-3611   Fax: 303-227-8798   www.c3gov.com 

                                                                             General Business License 
                                                                                          Form 101.0.04.17. 
                                                                                              Page 2 
  
__________________________________________________________________________________________________
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LIST POINT OF CONTACT FOR TAX AND AUDIT INQUIRIES: 
Tax Contact Name: ________________________________________________________________________________ 

Phone: _______________________________            Email: _____________________________________________ 

Federal Employer ID No. (FEIN): _______________________    Colorado State ID: __________________________ 

Estimated Start Date in Commerce City (Required): _____________      Estimated Tax Due: ________ 

Filing Frequency: ☐Monthly (more than $50 tax/month)           No. of Employees: __________ 

                  ☐Quarterly (less than $50 tax/month)         Full Time:  

                  ☐Annually (less than $10 tax/month)          Part Time:  

PLEASE LIST ALL PRIMARY OWNERS, PARTNERS, OFFICERS OR MEMBERS IN THE BUSINESS: 
Name: __________________________________________________       Title: _________________________________ 

Address: __________________________________ City: _______________________    State: _____ Zip: ________ 

Phone: __________________________________   Email: ________________________________________________ 

Name: __________________________________________________       Title: _________________________________ 

Address: __________________________________ City: _______________________    State: _____ Zip: ________ 

Phone: __________________________________   Email: ________________________________________________ 

Name: __________________________________________________       Title: _________________________________ 

Address: __________________________________ City: _______________________    State: _____ Zip: ________ 

Phone: __________________________________   Email: ________________________________________________ 

                   Attach additional ownership/officer sheets if necessary. 

IF YOU ACQUIRED THE BUSINESS IN WHOLE OR IN PART, PLEASE COMPLETE OR ☐ N/A 

Prior Owner’s Name: _____________________________________________________________________ 

Prior Owner’s Address: ___________________________________________________________________ 

City: ___________________________________________ State: _______   Zip: ___________________________ 

      7887 E. 60th Ave., Commerce City, CO 80022   Tel: 303-289-3611   Fax: 303-227-8798   www.c3gov.com 

                                                                           General Business License 
                                                                                         Form 101.0.04.17. 
                                                                                                 Page 3 
  
Date of Acquisition:                                           Purchase Price: _______________________________ 

Price of Personal Property (Furniture, Fixtures, Equipment & Supplies): ___________________________________ 

PROVIDE COPIES OF ANY OTHER PERMITS NEEDED TO REGULATE BUSINESS: 

☐ Colorado Department of Regulatory Affairs ☐ Colorado Department of Public Health & Environment 

☐ Tri-County Health Department              ☐ Colorado Department of Labor & Employment 

☐ Colorado Department of Human Services     ☐ Other (specify): Click here to enter text. 

☐ Not Applicable (N/A)                       

Do you store or display outdoor materials? 

☐ No                    ☐ Yes, specify type ______________________________ 

Do you store or use hazardous materials? 

☐ No                           ☐ Yes, specify. __________________________________ 

I hereby certify under penalty of perjury that the statements made herein are true, correct and complete to the best of my 
knowledge. I hereby acknowledge and agree that if I have provided any false or misleading information herein, the City of 
Commerce City is authorized to immediately suspend or revoke any license issued pursuant to this application and issue a 
Stop Work Order to the licensed business. I further agree that I and the business named herein shall comply with all 
requirements of the ordinances and regulations of the City of Commerce City, including the duty to supplement the 
information provided herein. This application is only for a City of Commerce City business license; additional land use, 
zoning, building permit or license approvals may be required.  

Applicant Signature: _________________________________________________________________   

Title: _______________________________________                  Date: ________________________ 

Applicant Name (Printed): ____________________________________________________________ 

Direct Phone Number: ________________________________________________________________ 

The City will occasionally email you relevant business and regulatory information unless you decide to opt out by 
checking this box ☐. 

  7887 E. 60th Ave., Commerce City, CO 80022   Tel: 303-289-3611   Fax: 303-227-8798   www.c3gov.com