CVR-2.03.01 REV 02-19-12
CITY OF LEWISTON
CHILD CARE PRESCHOOL BUSINESS LICENSE
Page 1 of 4
PURPOSE AND DEFINITION
CLASSIFICATION
All child care or preschool facilities and persons entering or engaged in the business of operating a child care or preschool
facility within the city, including private nurseries, kindergartens or any other private facility caring for children during either
the day or night are required to be licensed for the purpose of protecting and providing services to the citizens and
businesses of the City. The requirement for the city depends on the classification of the facility.
The Lewiston City Code defines child care as providing care for children under the age of thirteen (13) years of age for
compensation.
Private or parochial education facilities, summer day camps, or other programs and persons providing care of a child or
children related by blood or marriage (limited to 3 children), or a child or siblings of one family (limited to 3 children) in
addition to their own children are not required to obtain a license.
The classifications of child care facilities are based on the number of children for whom care is provided. They are as follows:
Family Child Care : 1-6 children*
Group Child Care: 7-12 children*
Child Care Center: 13 or more children
Preschool: 13 or more children
A preschool is a separate classification, defined as “a place of structured instruction where educational sessions last no longer
than four (4) consecutive hours, not governed by the State Board of Education.”
*A family or group day care facility operated within the operator’s home does not count their own children when
determining the classification of their facility. However, their children are counted in the child to staff ratios – point system.
Conditional Use Permits required for Group, Center and Preschool classifications if located in a residential Zone.
GENERAL REQUIREMENTS
FAMILY DAY CARE: 1-6 Children
1 The provider must be 18 years old or older. Persons 16 to 17 may provide care if directly supervised by the provider. A
provider or child care employee must not work when ill as per Rules and Regulations Governing Idaho Reportable
Diseases.
2. At least one (1) adult shall be on premises at all times who has a current certification in pediatric rescue breathing and
first aid treatment from a certified instructor;
3. Summer months or when public school is not in session, family child care facilities may allow up to a maximum of twelve
(12) children, including provider’s own children, without obtaining a city license for a Group child care facility if there is at
least one (1) child care employee or adult volunteer on duty.
4. A Business License is required, including an authorization for a background study for all owners, employees, regular
volunteers, substitutes, persons living at the facility who are thirteen (13) years of age or older, and any other persons
who will have access to or are directly responsible for the care and treatment of children in care;
5. A record of personal physician, health and immunization record and an emergency contact and number for each child are
to kept at the facility;
6. Compliance with State regulations, Building, Fire and Health Codes and City Standards is required. These regulations are
available on a checklist provided by the Community Development Department.
CVR-2.03.01 REV 11-01-09
CITY OF LEWISTON
CHILD CARE PRESCHOOL BUSINESS LICENSE
Page 2 of 4
GENERAL REQUIREMENTS (Cont’d)
GROUP DAY CARE: 7-12 Children
1. The provider must be 18 years old or older. Persons 16 to 17 may provide care if directly supervised by the provider. A
provider or child care employee must not work when ill as per Rules and Regulations Governing Idaho Reportable Diseases;
2. At least one (1) adult shall be on premises at all times who has a current certification in pediatric rescue breathing and first aid
treatment from a certified instructor;
3. Child to staff ratio not to exceed more than 12 points per staff person. Points are based upon ages of children;
4. Approval of a Conditional Use Permit from the Planning and Zoning Commission is required, except in a zone where Group
Day Care is listed as an outright use. A Conditional Use Permit requires a public hearing before the Planning and Zoning
Commission. For information on your zoning designation, contact Planning and Zoning at (208) 746-1318, extension 250;
5. A Business License is required, including an authorization for a background study for all owners, employees, regular volunteers,
substitutes, persons living at the facility who are thirteen (13) years of age or older, and any other persons who will have access
to or are directly responsible for the care and treatment of children in care;
6. A record of personal physician, health and immunization record and an emergency contact and number for each child are to be
kept at the facility;
7. Compliance with State regulations, Building, Fire and Health Codes and City Standards is required. These regulations are
available on a checklist provided by the Community Development Department.
DAY CARE CENTER: 13 Children or Over
1. The provider must be 18 years old or older. Persons 16 to 17 may provide care if directly supervised by the provider. A
provider or child care employee must not work when ill as per Rules and Regulations Governing Idaho Reportable Diseases.
2. At least one (1) adult shall be on premises at all times who has a current certification in pediatric rescue breathing and first aid
treatment from a certified instructor;
3. Child to staff ratio not to exceed more than 12 points per staff person. Points are based upon ages of children;
4. Approval of a Conditional Use Permit from the Planning and Zoning Commission is required, except in a zone where Day Care
Center is listed as an outright use. A Conditional Use Permit requires a public hearing before the Planning and Zoning
Commission. For information on your zoning designation, contact Planning and Zoning at (208) 746-1318, extension 250;
5. A Business License is required, including an authorization for a background study for all owners, employees, regular volunteers,
substitutes, persons living at the facility who are thirteen (13) years of age or older, and any other persons who will have access
to or are directly responsible for the care and treatment of children in care;
6. A record of personal physician, health and immunization record and an emergency contact and number for each child are to be
kept at the facility;
7. Compliance with State regulations, Building, Fire and Health Codes and City Standards is required. These regulations are
available on a checklist provided by the Community Development Department.
PRESCHOOL:
1. Approval of a Conditional Use Permit from the Planning and Zoning Commission is required, except in a zone where Preschool
is listed as an outright use. A Conditional Use Permit requires a public hearing before the Planning and Zoning Commission.
For information on your zoning designation, contact Planning and Zoning at (208) 746-1318, extension 250;
2. A Business License is required, including an authorization for a background study for all owners, employees, regular volunteers,
substitutes, persons living at the facility who are thirteen (13) years of age or older, and any other persons who will have access
to or are directly responsible for the care and treatment of children in care;
3. Compliance with State regulations, Building, Fire and Health Codes and City Standards is required. These regulations are
available on a checklist provided by the Community Development Department;
4. Preschool regulations are classified by the number of students ranging from: 12 or less; 13-50 students; and over 50 students;
5. Staffing ratios are one (1) adult staff member for each twelve (12) students.
6. At least one (1) adult shall be on premises at all times who has a current certification in pediatric rescue breathing and first aid
treatment from a certified instructor.
7. A record of personal physician, health and immunization record and an emergency contact and number for each child are to be
kept at the facility.
CVR-2.03.01 REV 11-01-09
CITY OF LEWISTON
CHILD CARE PRESCHOOL BUSINESS LICENSE
Page 3 of 4
LICENSE FEES
When the completed application has been received by the Business License Office, copies are sent to the Fire Department,
Building and Zoning Officials, and, in some instances, the Police Department and Health District.
The Zoning Official reviews the application to determine if the business is allowed in the zone. In some instances, a
conditional use permit may be required; if so, approval of the conditional use is required by the Planning and Zoning
Commission before a business license may be issued. ALL BUSINESS LOCATIONS WILL BE INSPECTED FOR COMPLIANCE WITH
THE LAWS OF THE STATE AND OF THE CITY. Inspections may be conducted by the Building Division, Fire Department, City
Sanitation and the North Central Health District Health Department.
The inspection will be arranged through the Building Division and will be scheduled at a time during the normal working day
convenient to the applicant. The Fire Department reviews the use and structure for fire and life safety requirements not
covered in the Building Code, i.e., water supply, Fire Department access and fire extinguishers. The Building Official reviews
the condition of the structure in relation to the request. The Building Division inspectors review for compliance with
adopted codes including electrical, mechanical and building codes. The Building Division also reviews the structure for
compliance with the Americans with Disabilities Act (ADA). The Health District and the Police Department may also review
some applications. Following the inspections, you will be given a letter containing inspector’s comments and/or a list of any
corrections that may be required. Some corrections may be required immediately, prior to occupancy; others may be
completed within a short period of time. During this period, the City, at its option, may issue a temporary thirty (30) day
provisional business license so you can open for business. If you do not complete the work within the time frame given, the
City may revoke your business license.
The license fee is calculated on number of employees. Refer to the Business & Occupation Fee Schedule for current rates license
fee, inspection fee and fingerprint fees. Fees are updated annually on October 1. Licenses are renewed annually.
REVIEW PROCESS
HOW TO APPLY
Applications and applicable forms are available at the Business Licensing office in the Community Development Department, 215
“D” Street. You may contact the Business Licensing office at (208) 746-7363 and request a child care or preschool packet. Please
specify the classification at the time of your request and the number of persons requiring a background study. (Please see
“fingerprinting” below).
The applicant should return to the Business Licensing office the following completed documents:
1. Application.
2. Background Study forms.
3. Site Plan of facility or residence and outside play area.
4. Copy of certification card for CPR/First Aid.
5. Applicable fees.
TIME FRAME
Licensing a child care or preschool facility normally takes about 15 working days. The initial background studies will be processed
before an inspection of the facility is scheduled. If a Conditional Use Permit is required, processing is an additional 8 weeks.
FINGERPRINTING
Annual fingerprinting is required for all owners, employees, regular volunteers, substitutes, persons living at the facility who are
thirteen (13) years of age or older and any other persons who will have access to or are directly responsible for the care and
treatment of children in care.
A full FBI fingerprint-based background study is required for all new persons and repeated every three (3) years. A limited WIN
fingerprint-based background study will be required annually each year in between the FBI background study. Please note: any new
persons added to a facility as a worker or resident during the license year – the facility owner is responsible to submit completed
background study forms for that person to the city immediately, and follow with fingerprint requirements.
CVR-2.03.01 REV 11-01-09
CITY OF LEWISTON
CHILD CARE PRESCHOOL BUSINESS LICENSE
ALL BUSINESS LICENSES MUST BE RENEWED ANNUALLY
Page 4 of 4
All premises in the City are assessed a minimum fee to fund the Solid Waste System. Contact the Utilities Division at 208-
746-1355 for information on the service and fee structure. Failure to contact the Utility Division and specify a service level
will result in the minimum fee being assessed.
SANITATION SERVICE
SIGNS
Most new signs and the replacement of existing signs require a construction permit. Signs are regulated by zoning, and the
type and size of sign you may erect is determined by your business location. Window signs are not generally regulated.
Portable reader board signs are illegal. Please contact the Zoning Official for more information at 208-746-1318.
REFUND POLICY
Withdrawal of Application – If, upon written request by the applicant to the Business Licensing Coordinator to withdraw an
application for license, a refund shall be granted, less a processing fee; provided however, that no investigation had been
conducted of the business premise or a license issued, in which case a refund shall not be granted.
OTHER CONTACTS:
IdahoStars Child Community Action Partnership – Dial 2-1-1 – www.idahostars.org
Care Program: 124 New 6
th
Street
Lewiston ID 83501
Idaho Child Care St. Vincent de Paul – (800) 482-5552
Food Program: 411 N 15
th
Street
Coeur d’Alene ID 83814
Register Idaho Secretary of State - (208) 334-2301 - www.sos.idaho.gov
your business: PO Box 83720
Boise ID 83720-0080
Federal taxes: Internal Revenue Service - (800) 829-1040 – www.irs.gov
Federal Bldg, Rm 327
550 W Fort St
Boise ID 83724-0041
State income and Idaho Tax Commission - (208)799-3491 - www.tax.idaho.gov *
other taxes: 1118 “F” Street
Lewiston ID 83501
Employment taxes, Idaho Department of Labor – (208) 799-5000 ext. 3937 or 3855 – www.labor.idaho.gov *
new hire, labor laws: 1158 Idaho St
Lewiston ID 83501
Worker’s Idaho Industrial Commission – (208) 799-5035 – www.iic.idaho.gov *
Compensation 1118 “F” Street
Insurance: Lewiston ID 83501
* For faster service, you may register with all three (Tax, Labor and Industrial Commissions) at: www. business.idaho.gov
215 D Street • PO Box 617 • Lewiston, ID 83501-1930 • Ph.208.746.1318 • Fx.208.746.5595 • www.cityoflewiston.org
CITY OF LEWISTON
PEDIATRIC CPR/FIRST AID CERTIFICATION
All child care and preschool facilities must have at least one (1) person on the licensed premises at all times who
has a current certification in pediatric rescue breathing and first aid treatment from a certified instructor. A copy
of the CPR First Aid certification must be provided to the City of Lewiston Business Licensing Office prior to the
issuance of a license for a new facility and each year thereafter at license renewal. Below is a list of local persons
and/or agencies available to provide certification.
AGENCY
INSTRUCTOR
CONTACT NUMBER
Asotin County Health Department
Jim Babino
(509) 295-3045
American Heart Association (Groups Only)
Anita
(509) 758-6349 – Home
American Red Cross
Staff
(800) 733-2767 Option 3
St. Joseph’s Regional Medical Center
American Heart Association
Karen Powell
(208) 799-5417
Firehouse Medics
Randy & Kristi Arnold
(208) 798-9218
McKenna CPR & First Aid Training
Melody McKenna
(509) 552-1278
215 D Street • PO Box 617 • Lewiston, ID 83501-1930 • Ph.208.746.1318 • Fx.208.746.5595 • www.cityoflewiston.org
CITY OF LEWISTON
CHILD CARE/PRESCHOOL STAFF RATIOS
FAMILY (6 OR LESS CHILDREN) CLASSIFICATION – MAXIMUM 12 POINTS PER STAFF
PERSON*
AGE OF CHILD
POINTS PER CHILD
Birth to less than 2 years
3
2 years to less than 3 years
2
3 years to less than 7 years
1
7 years to less than 13 years
.5
Children of the provider: when children of the provider reside on the facility premises, points for
the provider’s children over the age of five (5) years shall equal zero (0) points.
For child-staff ratio purposes, all children on premises are counted. Facility may increase from six (6) children up
to two (2) additional children to include the facility operator’s children and/or before and after school children
(first grad and up) without affecting the classification of the facility.
*The maximum number of children is eight (8) unless restricted by point system or facility occupant load as
determined by the International Building Code (IBC). When public school is not in session (summer, holiday
breaks and early releases), a Family facility may expand to a maximum of twelve (12) children, without a
Conditional Use Permit, when an additional staff person is present.
GROUP (7 TO 12 CHILDREN) CLASSIFICATION – MAXIMUM 12 POINTS PER STAFF
PERSON*
AGE OF CHILD
POINTS PER CHILD
Birth to less than 2 years
3
2 years to less than 3 years
2
3 years to less than 7 years
1
7 years to less than 13 years
.5
Children of the provider: when children of the provider reside on the facility premises, points for
the provider’s children over the age of five (5) years shall equal zero (0) points.
For staff-child ratio purposes, all children on premises are counted. Facility may increase up to four (4) additional
children to include own children and/or before and after school children (first grade and up) without affecting the
classification of the facility.
*The maximum number of children is 16, unless restricted by point system or facility occupant load as determined
by the International Building Code (IBC). Conditional Use Permit required in Residential Districts and two staff
members are required on the premises.
215 D Street • PO Box 617 • Lewiston, ID 83501-1930 • Ph.208.746.1318 • Fx.208.746.5595 • www.cityoflewiston.org
CENTER (13 OR MORE CHILDREN) CLASSIFICATION – MAXIMUM 12 POINTS PER STAFF
PERSON.
AGE OF CHILD
POINTS PER CHILD
Birth to less than 2 years
2
2 years to less than 3 years
1.5
3 years to less than 7 years
1
7 years to less than 13 years
.5
For staff-child ratio purposes, all children on premises are counted. Maximum number of children is established by
the facility occupant load as determined by the International Building Code. Conditional Use Permit is required in
Residential Districts.
PRESCHOOL CLASSIFICATION – MAXIMUM 12 POINTS PER STAFF PERSON
AGE OF CHILD
POINTS PER CHILD
3 years to less than 7 years
1
APP-2.01.0 REV 02-23-11
CITY OF LEWISTON
BUSINESS LICENSE APPLICATION
Incomplete applications will be rejected.
Wholesale Finance/Insurance Domestics Telephone Solicitation Alcohol
Retail Sales-New Personal Service Child Care/Preschool Health Care/Social Services Food Services
Retail Sales-Used Real Estate Repair--Automotive Taxicab Utilities
Manufacturing Rental/Leasing Repair--Other Christmas Tree Sales Transportation
Delivery Professional/Technical Educational Services Solicitation Door-to-Door Warehousing
Information (media) Outside Dining Arts/Entertainment Security/Armored Car Tree Pruner
Accommodation Recreation Hazardous Material Temporary Vendor Adult Material
Construction--Idaho Reg. No.: _____________ Pending Exempt Fireworks Stand Other _________
LICENSE AND FEES: Refer to Business & Occupation Fee Business License Fee $ __________
Schedule to determine fees. Real Estate and cosmetology Fee - Other $ ______________
establishments must also count independent agents or persons working under the licensed Inspection Fee $ ______________
broker or salon to eliminate need for separate licenses. Businesses without a physical
business location, count only number of employees working in Lewiston. Total Due $
I CERTIFY THE INFORMATION IS TRUE, CORRECT AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF.
**Signatures must be that of a responsible party.
Legal signatures include: sole proprietor-owner, corporate officer, partner, managing member or agent.
Check Type of License:
6
Idaho Name
(DBA):
Business Fax
( )
New Ownership Location Business Name Change in Change in Other
Business Change Change Change Corporate Officers Mailing Address _____________
PLEASE CHECK ALL THAT APPLY TO YOUR BUSINESS
Business Mailing
Street Number, Direction (N, S, E, W) and Name Suite, Unit, Apt # City, State, Zip Code
Address:
Lewiston Business Location:
Street Number, Direction (N, S, E, W) and Name Suite, Unit, Apt #
(If a physical location does not apply, write “none”)
BUSINESS OWNERSHIP – LIST ALL OWNERS, PARTNERS, CORP. OFFICERS (Attach additional sheet if needed)
General Business License
Commercial Location
No Physical Location
Home-based Business
License
Residential Location
Federal Tax Identification
Number
Business
Entity Type:
Corporate/Entity
(If different from DBA)
Name:
Corporate/Entity Telephone
( )
Responsible Local Contact:
Residence Address:
Ph: ( )
Number of
Employees: _________
12
Describe in Detail the Nature of Your Business in Lewiston. Include Product Sold, Labor Performed and/or Services Rendered.
**Signature
Print Name and Title
Date
**Signature
Print Name and Title
Date
Corporate/Entity
Street Number, Direction (N, S, E, W) and Name Suite, Unit, Apt # City, State, Zip Code
Address:
State of Incorporation or
Formation
Res. Address (Street)
Ph: ( )
Last, First, MI:
Title
Res. Address (Street)
City, State, Zip
Ph: ( )
Title
City, State, Zip
Sole Partnership Limited Liability Corporation Association Other
Proprietor Company __________________
Business E-mail
Address:
Last, First, MI:
Res. Address (Street)
Ph: ( )
Title
City, State, Zip
1
2
3
4
5
7
8
9
10
11
Last, First, MI:
13
15
Business Telephone
( )
Submit to: City of Lewiston, Business Licenses, PO Box 617 or 215 “D” St, Lewiston, ID 83501 Tele: (208) 746-7363 Fax: (208) 746-5595
LICENSE TERM AND ANNUAL RENEWAL: The license term is twelve (12) months from the date of license
issuance unless otherwise stated on the face of the license. A notice of invoice will be sent prior to the expiration
date on the face of the license. It shall be the responsibility of the licensee to renew the license annually, within
forty-five (45) days of the expiration date, whether or not a notice of invoice was received.
14
Acknowledge Term and
License Renewal:
Initial here: __________
ADD-2.03.1 REV 11-01-09
CITY OF LEWISTON
CHILD CARE PRESCHOOL ADDENDUM
This addendum is required for all child care or preschool facilities located in within the corporate city limits of Lewiston. It must your
accompany your application for a business license. Submit application and attachments to: City of Lewiston, Business Licensing, 215 “D” St or
PO Box 617, Lewiston ID 83501. Questions may be directed to Business Licensing at (208) 746-7363 or [email protected].
This Addendum is for the Business Lewiston
Street Number, Direction (N, S, E, W) and Name Suite, Unit, Apt #
Business & Address of: Name: Location:
LIST BELOW ALL PERSONS WORKING, VOLUNTEERING OR LIVING (13 YEARS OF AGE OR OLDER) AT THIS FACILITY
Community Development, Business Licensing Office, 215 “D” St, Lewiston ID 83501 Tele: (208) 746-7363 Fax: (208) 746-5595
CPR/First Aid
1.
All persons listed 13 years of age or older are required to complete a consent for background study form(s). FBI Fingerprints are required
on the initial background study and repeated every three (3) years and processed through ID Dept. of Health & Welfare. WIN Fingerprints
are required in the interim years between FBI checks and processed through the City of Lewiston.
________
FBI WIN
2.
________
FBI WIN
3.
________
FBI WIN
4.
________
FBI WIN
5.
________
FBI WIN
6.
________
FBI WIN
7.
________
FBI WIN
8.
________
FBI WIN
9.
________
FBI WIN
10.
________
__
FBI WIN
Pediatric CPR/First Aid Certification required for at least one (1) person who is on the licensed premises at all times during the hours of
operation when children are in care.
11.
________
FBI WIN
12.
Background Study & Fingerprints
________
FBI WIN
resident employee
volunteer substitute
Relationship to Facility
Birth Year
CPR/First Aid Expires
Fingerprints
Month Year
_____ __________
PLEASE COMPLETE THE FOLLOWING QUESTIONS
Classification: Family (1-6 children) Group (7-12 children) Center (13 or more children) Preschool
1. What will be your hours of operation? Begin Time: ______________ a.m./p.m.
End Time: ______________ a.m./p.m.
2. Will you provide hot meals? Yes No
3. Will you provide overnight care? Yes No
4. What school district are you
located in?_____________________
5. Ages of children you will offer care
for? From ______ yrs. to ______ yrs.
Last name, First Name, Middle Initial
resident employee
volunteer substitute
resident employee
volunteer substitute
resident employee
volunteer substitute
resident employee
volunteer substitute
resident employee
volunteer substitute
resident employee
volunteer substitute
resident employee
volunteer substitute
resident employee
volunteer substitute
resident employee
volunteer substitute
resident employee
volunteer substitute
resident employee
volunteer substitute
Month Year
_____ __________
Month Year
_____ __________
Month Year
_____ __________
Month Year
_____ __________
Month Year
_____ __________
Month Year
_____ __________
Month Year
_____ __________
Month Year
_____ __________
Month Year
_____ __________
Month Year
_____ __________
Month Year
_____ __________
ATTACH A COMPLETE FLOOR & SITE PLAN OF YOUR FACILITY
Bathroom
Laundry
& Pantry
C
WH & F
Sample
Plan
Sidewalk
`
Property Address of: (House Number, Street Name)
45’
15’
30’
45’
24’
21’
Garage
Living Room
Dining
Kitchen
Bedroom
MAIN FLOOR PLAN
Sliding
Glass Door
Deck
N
Driveway
Entrance
Exit
Child Care Floor/Site Plan
Drawing - Residential
Gravel Driveway
Accessory
Building
(Shop)
Property Line
Property Line
Property Line
Property Line
150’
100’
Residence/Total 1710 sg. ft.
Play Area = 450 sq.ft.
Activity Area = 240 sq.ft.
Sleep Area = 132 sq.ft.
Total inside use: 822 sq.ft.
1. Draw the level of your
residence where child care
activity will be conducted (main,
basement, 2
nd
story).
2. Label rooms, dimensions,
stairways, entry/exit locations.
3. Identify all areas inside and
outside of residence to be used
for child care or preschool
activities (office, play, sleep and
other activity areas, drop off
and pick up location, parking,
etc.)
Not to Scale
Drop off
and pick up
area
Play
Area
30’ x 15’
Activity
Area
20’ x 12’
Bedroom
Sleep Area
12’ x 11’
Fence
Gate
Fence
Fence
Gate
Outside
Play area
Commerical
W
D
Cashier
Area
Sample
Plan
Property Address: 1234 City Street
55’
15’
30’
30’
Sidewalk
Restrooms
Break
Room
Storage
N
Entrance
Exit
City Street
Customer Area
1. Identify how you will use the
space within business premises.
Label all areas.
2. Show dimensions of rooms,
stairways, entry/exit locations.
3. Show customer, employee,
and handicap parking.
Not to Scale
Exit
Office
Exit
H.C.
H. C.
Sidewalk
Storage
Parking
Parking
65’
Dumpster
Exit
Parking
Sidewalk
Sidewalk
Sidewalk
215 D Street • PO Box 617 • Lewiston, ID 83501-1930 • Ph.208.746.1318 • Fx.208.746.5595 • www.cityoflewiston.org
ADD-2.01.2 REV 11-01-09
CITY OF LEWISTON
LOCAL EMERGENCY SERVICES INFORMATION
This addendum is required for all commercial businesses located within the corporate city limits of Lewiston
And must accompany your application for a business license. In the event of an emergency at your business
premises during non-business hours, provide LOCAL emergency contact information of responsible parties of the
business, and contact information for the building owner and/or property manager to the Police and Fire Depts.
Persons listed below must have keys or access to the building and who may be contacted by Police or Fire
Emergency Services. Submit with application to: City of Lewiston, Business Licensing, 215 “D” St or PO Box 617,
Lewiston ID 83501 Questions may be directed to Business Licensing at (208) 746-7363.
Lewiston
Location:
( )
This addendum is for
the Business and
Address Of:
Is there a Security or Alarm System at
this location? Yes No
Business
Name:
Business Telephone
( )
Responsible
Name:
Title
City,
State, Zip
Res.
Address:
Res. Tele.
( )
IMPORTANT: Any changes in the above information should be forwarded to the Lewiston Police Department,
1224 “F” St, PO Box 617, Lewiston ID 83501. Bus. Tele: (208) 746-0171
Res.
Address:
Responsible
Name:
Cell. Tele:
( )
Title
City,
State, Zip
LOCAL EMERGENCY CONTACT INFORMATION
SECONDARY LOCAL CONTACT
THIRD LOCAL CONTACT
Res. Tele.
( )
Cell. Tele:
( )
Res.
Address:
Res. Tele.
( )
Responsible
Name:
Cell. Tele:
( )
Title
City,
State, Zip
PRIMARY LOCAL CONTACT
Res.
Address:
Res. Tele.
( )
Responsible
Name:
Cell. Tele:
( )
Title
City,
State, Zip
BUILDING OWNER CONTACT
CONTACT