1. The date of the application.

2. The applicant shall state the legal name, previous names, aliases, date of birth, and submit proof that the applicant is at least 18 years of age.

3. The height, weight, hair and eye color of the applicant.

4. The present mailing and residential address of the applicant.

5. The name and address of the adult entertainment facility at which the applicant will work or perform.

6. A description of the principal activities or services to be rendered by the applicant at the adult entertainment facility.

7. Two two-inch by two-inch color photographs of the applicant, taken within six months of the date of the application, showing the full face of the applicant. The photographs shall be provided at the expense of the applicant.

8. A complete set of fingerprints of the applicant, taken by a designated city official, on a form adopted and approved by the city of Bothell police department.

9. A statement whether the applicant has been convicted of a specified criminal offense, and if so, the date, place, and jurisdiction of each specified criminal offense.

10. A statement whether the applicant holds any license issued under this chapter or under a similar ordinance from another city or county, and if so, the operating names and locations of the other licensed businesses.

11. A statement whether the applicant has had a previous license issued under this chapter denied, suspended, or revoked, and if so, the name and location of the adult entertainment facility for which the license was denied, suspended, or revoked, as well as the date of the denial, suspension, or revocation.

12. Authorization for the city, its agents, and employees to seek information to confirm any statements or other information set forth in the application.