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Residential / Duplex Building Permit Application

  1. Roosevelt City Corporation Building Department

    255 State Street
    Roosevelt, UT 84066
    Phone: 435-722-5001
    Fax: 435-722-5000
    Email: djohnson@rooseveltcity.com

  2. Job Site Information

  3. Who will be paying for the monthly utility bill when the water meter is installed?

  4. Note: 24 Hour Notice on Inspections

  5. Building Permit Information

  6. Permit Information

  7. Number of Bedrooms

  8. Number of Bathrooms

  9. Owner Occupied

  10. Renter Occupied

  11. Garage

  12. Attached Garage

  13. Water Meter Size

  14. Carport

  15. Attached Carport

  16. Sewer Type

  17. Secondary Water Service on Property

  18. Notice: You are required to properly contain building litter and debris on building site. Use an authorized container according to Title 8 Health and Safety Code of Roosevelt City. Violators will be cited.

  19. General Contractor

  20. If Owner/Builder

  21. If same as Property Owner Name -
    Go To Electrical Contractor Section

  22. Paid by

  23. Decisions relative to this application are subject to review by the chief executive officer of the municipal or county entity issuing this building permit and appeal under the International Building Code as adopted by Legislature. This permit becomes null and void if work or construction authorized is not commenced I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local authority regulating construction or performance of construction and that I make this statement under penalty of perjury.

  24. 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.

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