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Other License Application
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Applicant is seeking a license to operate as one of the following:
*
-- Select One --
Ship Chandler, Ship Repair
Crane Operators License, Crane Service
Bunkering License
Miscellaneous Activity
Licensing Fees
Crane Service Annual Fee $3,000 / $1,500 after July 1
Bunkering Annual Fee $1,000 / $500 after July 1
Ship Chandler, Ship Repair Annual Fee $500 / $250 After July 1
Towing Company Annual Fee $1,500 / $750 After July 1
If miscellaneous activity, write activity here:
Name of Company
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Mailing Information
Contact Name
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Title
Mailing Address
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Mailing Address 2
City
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State
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Zip
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Phone Number
*
Fax Number
Email Address
Corporate Officer or Owner’s Information
Corporate Officer or Owner’s Name
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Title
Address 1
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Address 2
City
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State
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Zip
*
Phone Number
*
Fax Number
Email Address
Business Information
Type of Ownership
*
-- Select One --
Sole Proprietorship
Partnership
Corporation
Joint Venture
Date of Incorporation or Creation
*
Type of Business to Be Conducted on Premises
*
Number of Vehicles to Work at Port
Number of Employees to work at Port
List Three Business References, Including Names, Addresses, and Phone Numbers
*
Signature
The applicant agrees that when this application is approved and a license is granted to abide by all the rules and regulations of the Port of Palm Beach District and all the provisions of the Port of Palm Beach District Tariff, as amended periodically. Nothing contained herein shall relieve Applicant or its employees from the obligation to comply with security requirements now existing or hereinafter imposed by the Port of Palm Beach District, Local, State, and Federal Authorities.
Name and Title
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Date
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County Of
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