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CITY OF BANGOR – LICENSE APPLICATION

RETURN TO: City Clerk, 73 Harlow Street, Bangor, Maine 04401 (207)992-4200 FAX: (207)945-4449

|License No.: | |Date: | |License Fee: | |

|Expiration Date of Current License: | |Public Notice Fee: | |

|License Type: | |Total Due: | |

|Business Name: | |

|Physical Address: | |

|Mailing Address: | |

|Telephone: | |Email Address: | |

|Owner: | |

|Mailing Address: | |

|Telephone: | |

|Contacts: | |

|Mailing Address: | |

|Telephone: | |Email Address: | |

I hereby certify that this business is in compliance with all state and local laws and ordinances. City of Bangor Code, Chapter 85, 85-1( 85-4.

|Applicant’s Signature: | |

(ALL FEES SUBMITTED SHALL BE RETAINED BY THE CITY CLERK REGARDLESS OF WHETHER SAID LICENSE OR PERMIT IS ISSUED)

Please Fill Out The Appropriate Information Below:

|Amusement Devices: |How Many | | |

|Carnival: 1 to 5 rides | | 6 rides and| |Circus: Indoor | |Outdoor |

| | |over | | | | |

|Innkeeper: Under 10 Rooms | | Over 10 Rooms | | |

|Lunch Wagon: License Plate # | |Make/Year of Vehicle |«LWYrMake» |

| Up to 3 days | | Up to 3 Months | | Over 3 Months Up to 1 Year | | |

Dates for 3 Day or 3 Month Lunch Wagon License:_________________________ Location or Event:____________________

|Theater: Seating Capacity | | |

|Mobile Home Park: <100 Lots | |

|Victualer’s License: No Tables | |< 2,000 Sq. Ft. | |> 2,000 Sq. Ft. | |Attach Copy of State License. |

|Please Attach: Completed Annual Grease Trap Maintenance Log, including % of solids & grease in trap. If maintained by a third party, please include invoices. |

Beano, Junkyard/Metal Recycling, Liquor Licenses and Special Amusement Licenses require City Council Approval

The undersigned being the Municipal Officers of the City of Bangor, Maine, hereby certify that we have given Public Notice in this application and have held a Public Hearing and hereby approve said application.

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