HomeMy WebLinkAboutEntertainer License Application
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City of Renton Tax & Licensing • 1055 S Grady Way, Renton, WA 98057 • 425-430-6851 • taxandlicensing@rentonwa.gov • rentonwa.gov
City of Renton Tax & Licensing Adult Entertainer License Application
FOR ADULT BUSINESS, ENTERTAINER, OR MANAGER
REGISTRATION CHECKLIST
☐ Complete, signed, and notarized application
Non-Refundable License Fee ☐ Complete, signed Renton Business License application
☐ Copy of photo ID verifying applicant is 18 years of age or older
License fees are non-refundable and must be submitted with the
complete, notarized application. ☐ Two passport photos (2: x 2) of the applicant taken within six (6)
months of the date of this application
$750.00 Business $75.00 Manager ☐ A complete set of fingerprints for the applicant (not required if
prints were previously submitted to the city).
$75.00 Entertainer $5.00 License replacement ☐ Payment: 1) Entertainer or Manager License AND
2) Renton Business License – Entertainer only
Applicant: ☐ Adult entertainment business ☐ Manager ☐ Entertainer
Application type: ☐ Initial application ☐ Renewal (prior Renton license #):
Full Legal Name: Date of Birth:
Alias: Phone:
Stage name(s): Email:
Previous name(s): Driver’s
License #:
Social Security #: State issued:
Home address: Business
address:
KNOW YOUR RIGHTS TRAINING
I have completed the Know Your Rights training with the State of Washington: ☐ Yes ☐ No
CRIMINAL HISTORY
Within the past five (5) years of the date of this application, have you been convicted, forfeited bail, or been
subject to an adverse finding under Federal, State, or local law for acts including, but not limited to, sexual
crimes against children; sexual abuse; rape; distribution of obscenity; distribution of erotic material to
minors; prostitution; promoting prostitution; transporting persons for purposes of prostitution or enticing or
coercing persons to travel for purposes of prostitution; permitting prostitution; patronizing a prostitute;
pandering; racketeering; or violations of the Uniform Controlled Substances Act?
☐ Yes ☐ No
If you answered “Yes” to the question above, describe below any and all criminal activity within the past 5 years of the date of this
application. Use additional sheets if necessary.
Activity Date:
(conviction/bail/forfeiture/adverse finding) Nature of crime/details Location of crime Associated with adult
entertainment?
☐ Yes ☐ No
☐ Yes ☐ No
☐ Yes ☐ No
☐ Yes ☐ No
☐ Yes ☐ No
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City of Renton Tax & Licensing • 1055 S Grady Way, Renton, WA 98057 • 425-430-6851 • taxandlicensing@rentonwa.gov • rentonwa.gov
City of Renton Tax & Licensing Adult Entertainer License Application
FOR ADULT BUSINESS, ENTERTAINER, OR MANAGER
PREVIOUS EMPLOYMENT HISTORY
Provide the name(s), addresses, and dates of employment for all employers, individuals, or businesses for whom you were an
employee or independent contractor for the period of two (2) years prior to the date of this application.
Employer name: Employer address: Dates of employment:
CURRENT EMPLOYMENT
Provide the name(s) and addresses of each adult entertainment business where you are currently employed as an entertainer.
Business name: Business address:
CERTIFICATION
I, ____________________________________________________, affirm that I am the above-named applicant and declare under penalties for
perjury and/or revocation of any license granted, that the information provided on this application and any accompanying information has
been examined by me and are true, correct, and complete. I hereby authorize the City of Renton, its agents, and employees, to investigate
and confirm any statements set forth in this application. Further, I understand that falsifications or omissions on the application are
grounds for denial, suspension, or revocation of the license.
Date: _____________ Signature: Printed Name: ___
STATE OF WASHINGTON )
COUNTY OF KING )
I certify that I know or have satisfactory evidence that ___________ signed this instrument and
acknowledged it to be his/her/their free and voluntary act for the uses and purposes mentioned in this instrument.
Notary Public in and for the State of Washington
Notary (print):
My appointment expires: Dated: