Rental Dwelling License Application Single Family


Rental Dwelling License Application
Single Family or Duplex
Ogden City Customer Service Center
2549 Washington Blvd. Suite 240
Ogden, Utah 84401
License #
Phone: 801-629-8985
 New License
New Owner
Adding dwelling Removing dwelling
Fed ID # ______________
Business information:
(Please print legibly)
Licensee name:___________________________________________________Phone_________________________
(as it will appear on business license)
Address:_______________________________________________ City_______________State_____Zip_________
Are you a
Limited Liability Company
Limited Liability Partnership Partnership
Individual/Sole Proprietorship
Business name or DBA name (if different from above)_____________________________________________________
Individual/Sole Proprietors: We need your date of birth ______________ and Driver’s License #___________________
Contact person:_______________________________________________ Email_______________________________
Mailing address__________________________________________City______________State______Zip_________
(This is where all licenses and renewal notices will be sent!)
Rental Property Information
Rental Dwelling Address:________________________________________________Ogden, UT __________________
(Check one)
Manager name:____________________________ Phone #____________________ Email _____________________
Address:_________________________________________________ Ogden , UT ____________________________
(If you own more than one rental, please complete the reverse side)
Good Landlord Incentive Discounted License Fees
Rental Licensing Fees
GLL Cert. #_________________
Number of single
Number of single
dwelling units _____x $156 ea.=______________
dwelling units _____x $13 ea. =______________
Number of
Number of
Duplexes _______ x $140 ea. = ______________
Duplexes _______ x $12 ea. = ______________
Is duplex owner-occupied?
Is duplex owner occupied?
Owner occupied
Owner occupied
Duplexes _______ x $35 ea. = ______________
Duplexes _______ x $3 ea. = _______________
GLL Discount Subtotal:
Late fees @ _______%
Late fees @ _______%
Total Due
Total Due
This is an application for a business license. Its submission does not constitute issuance of a license, which will only
occur after all fees are paid.
I, we ________________________________________(print name of signatory) hereby certifies under penalty of law
that the information contained herein is true and correct.
Applicant/Authorized representative
Cashier Codes:
1000-1-21100__________________ 1000-1-21200____________________ 1000-1-21550______________________
X:business licenses/forms&checklist/cust.svc.counter forms/SFD form


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