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2. Date:
   Date:
4. License No.:
   for office use only
6. Application for Non-Domicile, Home Occupation and Administrative & Retail Occupational Licenses

8. In order to obtain a Roeland Park Business /Occupational License, building trades must have a Johnson County Contractors License and roofing contractors must also have a Kansas Roofer Registration.

10. City of Roeland Park, Kansas
12. Company Name*
13. Contact Name
15. Physical Address*
16. City*
18. State*
19. Zip Code*
21. Phone Number*
22. Email Address*
24. Type of Business:*
28. If mailing address is different than physical address, please indicate below:
30. Mailing Address
31. City
33. State
34. Zip Code
38. Type of License*
    -- Select One --Home Occupation $40.00Massage Establishment $150.00Non-Domicile Business $80.00 (reduced to $40 after June 1st)Retail & Administrative Offices (see sq ft chart)Massage Therapist $50.00
39. If applying for a Retail/Administrative Business License, please indicate number of sq. ft. of your establishment:
43. Those seeking to license in-home daycare with more than three children, must complete a Special Use Permit Application and pay the associated fees and obtain approval from the City Planning Commission (Ord. 961, adopted 11/20/2017). Approval expires after five years. Annual renewals require a copy of the state licensure.
47. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
49. Electronic Signature*
Leave This Blank:


51. 1. Receive an email copy of this form.
52. Email address

    This field is not part of the form submission.

53. Submit Submit and Print

* indicates a required field