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Business License Application

  1. Roosevelt City Corporation

    255 South Street
    Roosevelt, UT 84066
    Phone: 435-722-5001
    Fax: 435-722-5000

  2. Return all completed and properly signed forms (including attachments as necessary) along with applicable licenses fees to Roosevelt City Corporation.

  3. Business License Application: $100.00
    Remit payment with cash, check debit or credit card

  4. Business Information

  5. Business Status

  6. Type of Organization

  7. Nature of Business

  8. Is the business a mobile unit and will be parked in a parking lot to conduct the business?

  9. If Yes, a letter from the parking lot owner is required with this application.

  10. Will the business use, store or manufacture any chemical or hazardous materials?

  11. Is the business an Eating Establishment?

  12. If yes, Uintah Basin Health Department has regulations regarding this type of business which includes an inspection of the premise. When clearance is given you will be issued a permit to conduct business. Include a copy of the permit with this application. Also, food handler’s permits will be required to handle food items.

  13. If you have license by the State of Utah, complete this section

  14. Will the business use, store or manufacture any chemical or hazardous materials?

  15. The following licenses are subject to additional requirements. More information and additional form(s) will be required.

    Check if applicable

  16. If applicant is a Sole Proprietor, complete this section

  17. Manager Information (if applicable, if not skip this section)

  18. If application is a Corporation, Partnership, or LLC, complete this section, if not skip this section

  19. I am aware that this application does not constitute approval to operate a business. I hereby agree to conduct said business strictly in accordance with the laws and ordinances covering such business and swear under penalty of law that the information contained herein is true.

  20. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  21. Leave This Blank:

  22. This field is not part of the form submission.