Occupational License Application

2. Date
   Date

4. Name of Business

5. Business Phone

7. Street Address

9. Mailing Address

11. City

12. State

13. Zip Code

15. Classification of Business

    Briefly describe the major line/primary type of business/service to be offered.

17. Number of full-time employees:

    Includes owner/manager

18. Number of part-time employees:

19. Anticipated number of hours to be worked by part-time employees:

21. Plumbing/HVAC/Electrical Contractors must furnish State Certification Number:

23. Owner's Name

24. Owner's Phone Number

26. Owner's Address

28. City

29. State

30. Zip Code

32. Note:
    All licenses must be renewed by March 31 of each year regardless of the date of issuance. Licenses are not transferable from one person to another or business. Certain applications/stipulations may apply and may require the approval of the Mayor and Council. Please call Grovetown Licensing & Permits with any questions at 706-860-5094.

    All licenses must be renewed by March 31 of each year regardless of the date of issuance. Licenses are not transferable from one person to another or business. Certain applications/stipulations may apply and may require the approval of the Mayor and Council. Please call Grovetown Licensing & Permits with any questions at 706-860-5094.

34. I certify that the above information is true and correct. I understand that falsification of any part of this application could cause denial, suspension, or revocation.

36. Signature of Applicant/Owner

37. Date
    Date

39. Approved/Denied

    1. Approved
    2. Denied

40. Date Approved
    Date Approved

42. License Number

43. Council Approval

44. Meeting Date
    Meeting Date

46. Mayor

47. City Clerk

51. Zoning Recommendations

55. By signing/affixing signature below, I, the applicant/owner of the above noted business do hereby state that I have read and fully understand the noted stipulations for obtaining an occupational license for the above named business. I further state that I am aware that failure to comply with the stipulations will result in the suspension or revocation of said occupational license.

57. Signature of owner/applicant

58. Date
    Date

62. O.C.G.A. §50-36-1(e)(2) Affidavit
    O.C.G.A. §50-36-1(e)(2) Affidavit (PDF)

    This Affidavit must be completed.

63. Upload Completed Affidavit*

65. Private Employer Exemption Affidavit Pursuant to O.C.G.A. §36-60-6(d)
    Private Employer Exemption Affidavit (PDF)

    Complete if you have 10 or less employees.

66. Upload Completed Affidavit*

Leave This Blank:


68. 1. Receive an email copy of this form.
69. Email address

    This field is not part of the form submission.

70. Submit

* indicates a required field