City of Leoti, Kansas

* Today's Date:

* First Name:

* Last Name:

Address:

City:

State:

Zip Code:

* Phone Number:

Additional Phone Number:

Company Name:

The following documentation must be submitted when applying for the following City Licenses:

Electrical License:

Plumbing License:

Roofing License:

General License:

1. Application form ( City License Form);
2. Proof of current Certificate of Liability lnsurnnce
3. Proof of current Kansas State Sales Tax Number

Liquor License:

Solicitation License:

Amusement Machine License:

1. Application form ( City License Form);
2. Copy of State Liquor License

1. Application Form (City License Form);
2. Copy of Driver's License/ID

1. Application form ( City License Form);

I hereby certify that I have read and examined this application and know the same to be tme and correct. All provisions of Laws and Ordinances Governing this type of work will be complied with whether specified or not. The granting of a City License does not presume to give authority to violate or cancel the provisions of any other state or local law.

I hereby agree, upon the condition of the issuance ofa City License as requested in this application, to indemnify and hold the same City free from loss, liability, or damage which may result from my actions hereunder.

Applicant Name:

Date:

City License Application Form