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2. First Name*
3. Last Name*
5. Applicant Mailing Address
7. City
8. State
9. Zip
11. Email Address*
12. Phone Number*
16. Business Name*
18. Business Address
20. City
21. State
22. Zip
24. Email Address*
25. Phone Number*
27. State Tax ID
28. Federal Tax ID
32. Description and Location (for permanent locations) of the premises to be licensed. *
34. Submission of Plans and Specifications

    Applicants must submit plans and specifications for the sauna establishment, including the following:

    (1) The proposed layout

    (2) Photographs

    (3) Mechanical schematics

    (4) Construction materials

    (5) Finish schedules

    (6) Equipment types

    (7) Manufacturers

    (8) Model numbers

    (9) Locations

    (10) Dimensions

    (11) Performance capacities

    (12) Power Source

    (13) Installation specifications

    (14) Information on any custom fabricated equipment

    The city may inspect the sauna establishment, consistent with application law, as frequently as the city deems necessary during construction to ensure that construction occurs in conformance with applicable law. 

36. Attach a Scaled Diagram/ Plans and Specifications of of Premises & Furnishings or Mobile Unit Diagram/layout*
38. Additional Information

    Based on the type of business license selected, additional information may be requested by the Administration Office and additional paperwork may be required for a specific license.

42. Proof of Liability and Property Damage Insurance

    Applicant must provide proof of liability and property damage insurance in the amount of at least one million dollars ($1,000,000) per occurrence. No license issued under this Ordinance is valid unless the required insurance is maintained and the license holder files evidence of its continuance with the City Administration office. 

    The information required is: 

    - Name of Insurance company

    - Policy Number

    - Dates of Coverage

    - Liability and Property Damage Covered amount listed

44. Name of Insurance Company*
45. Policy Number*
47. Dates of Coverage*
    Dates of Coverage Start Date

    —

    Dates of Coverage End Date
48. Coverage Amount (Liability & Property Damage)*
50. Proof of Insurance file upload*
54. Proof of Workers' Compensation Insurance

    Minnesota Statute Section 176.182 requires every state and local licensing agency to withhold the issuance or renewal of a license or permit to operate a business in Minnesota until the applicant presents acceptable evidence of compliance with workers' compensation insurance coverage requirement of Section 176.181 Subd. 2.  The information required is:

    - the name of the insurance company

    - the policy number

    - dates of coverage

    - or the permit to self-insure

    This information will be collected by the licensing agency (the City) for the records file.  It will be furnished, upon request, to the Department of Labor and Industry to check for compliance.

    This information is required by law, and licenses and permits to operate a business may not be issued or renewed if it is not provided and/or falsely reported.  Furthermore, if this information is not provided and/or falsely reported, it may result in a $2,000 penalty assessed against the applicant by the Commissioner of the Department of Labor and Industry payable to the Special Compensation Fund.

    Provide the information specified above in the spaces provided, or certify the precise reason your business is excluded from compliance with the insurance coverage requirement for workers' compensation.

56. Insurance Company Name
57. Policy Number or Self-Insurance Permit Number
59. Dates of Coverage
    Dates of Coverage Start Date

    —

    Dates of Coverage End Date
60. Permit to Self Insure
62. Or I am not required to have workers' compensation liability because:
64. Choose One
    -- Select One --I have no employees covered by the law.Other - Specify
65. Specify Reason
67. Insurance Information

    I have read and understand my rights and obligations with regards to business licenses, permits and workers' compensation coverage, and I certify that the information provided is true and correct.

69. Electronic Signature Consent

    By electronically signing the Business License Application, the applicant consents the e-signature legally binds them to the terms and conditions of the application.

71. E-signature of Applicant*
72. Date*
    Date
Leave This Blank:


74. 1. Receive an email copy of this form.
75. Email address

    This field is not part of the form submission.

76. Submit

* indicates a required field