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City of Omak
PEDDLER
PERMIT
Name ___________________________________________________ Birthday___-___-___
First
Middle
Last
Social
Security#_____-____-_____ Driver License #____________________ Home
Phone#______________
Physical
Address:__________________________________________________________________________
Mailing
Address____________________________________________________________________________
UBI (Uniform
Business Identifier) #_____-_____-_____ Type of
Business___________________________
Registered Business
Owners Name: ____________________________________Phone
#________________
First
Middle
Last
Address______________________________________________________________________________
Vehicle___________________________________________________________________________________
Color / Year /
Make / Model /
License / State
Vehicle___________________________________________________________________________________
Color / Year /
Make / Model /
License / State
List all
other vehicles or means of transport being used to pursue activity on back of
sheet)
Length of time you will sell ___________________Location
where you will sell ________________________
I certify
the information on this application is correct. I agree to comply with Ordinance
#1251.
I understand there is a ten day waiting period and the application fee
is $25.
_____________________________________________________Date________________
Signed
_____________________________________________________Date________________
Witness
If you plan on
conducting business on the Colville Indian Reservation you should become
familiar
with the T.E.R.O. Act (Indian Preference Employment) Questions? Call
1-800-634-2719
_________________________________________________________________________________________
OMAK POLICE DEPARTMENT USE ONLY BELOW
THIS LINE
Copy of Driver
License
Photo
Fingerprints NCIC III
UBI
confirmed Business Owner
verified Business name verified
UBI,
business owner and business names can all be verified though master license
(360) 664-1414/826-7345
________________________________________________________________________________________________________
_____Approved ______Denied By:
__________________________Date______________ Given Copy of Ordinance
_____________Initial | 
