Class A, B, C License Application

2. Application For:*

   1. New

   1. Renewal

   1. Bond Expiration

3. License Number

   If you selected "Renewal", please fill in your existing license number here.

5. License Class*

   1. Class A - General ($400)

   1. Class B - Building ($200)

   1. Class C - Residential ($100)

7. Proof of Insurance*

8. Copy of Wichita or Sedgwick County Master License*

12. Name of Business*

13. Business Conducted As:

    1. Individual

    1. Partnership

    1. Corporation

15. Business Address*

17. City*

18. State*

19. Zip Code*

21. Phone Number*

22. Email Address

24. Fax Number

28. Personnel of Business

30. Name

31. Office or Position

33. Name

34. Office or Position

36. Name

37. Office or Position

41. Person(s) Authorized to Obtain Permits and Request Inspections:

43. Name

44. Office or Position

46. Name

47. Office or Position

49. Name

50. Office or Position

52. Name

53. Office or Position

57. Are there any liens, suits, or judgments now pending against you or the business party?*

    1. Yes

    1. No

58. Have you or the organization filed for bankruptcy during the past year?*

    1. Yes

    1. No

60. Who is financially responsible for the business?*

62. Please indicate if you would like to include your company on the Bel Aire website list of licensed contractors. No additional charge.

    1. Yes

    1. No

66. Statement of Agreement

    <strong>In submitting this application, it is understood that the applicant whose electronic signature appears below agrees to comply with the provisions of the codes, ordinances, and resolutions applicable and that it is unlawful for a licensee to allow his or her name or license to be used by another, and farther that a license may be revoked for reason of misrepresentation of facts in obtaining such license.</strong>

    In submitting this application, it is understood that the applicant whose electronic signature appears below agrees to comply with the provisions of the codes, ordinances, and resolutions applicable and that it is unlawful for a licensee to allow his or her name or license to be used by another, and farther that a license may be revoked for reason of misrepresentation of facts in obtaining such license.

68. Signature (Owner)*

69. Date*
    Date

71. Will you mail your payment to City Hall?

    1. Yes
    2. No

    
    The application's payment by check or money order for the license is to be submitted to:
    City of Bel Aire
    Department of Community Development
    7651 E Central Park Avenue
    Bel Aire, KS 67226
    

72. Would you like to pay over the phone?

    1. Yes
    2. No

    
    There is a 2.5% service fee of the total transaction amount for all credit/debit cards. Flat $1.50 service fee for electronic checks.
    ***Once the application has been reviewed and processed, you will receive a phone call for payment.

76. Acceptance or Rejection

    1. Issue the License

    1. Reject the License

78. Approved by:

79. Date
    Date

Leave This Blank:


81. 1. Receive an email copy of this form.
82. Email address

    This field is not part of the form submission.

83. Submit

* indicates a required field