(Please complete spaces below in legible manner and provide authorized signature/date)

Type 1



 
Type 2



 
Type 3



 
Type 4



 
Type 5



 

Calculation of Fee: Base fee of $150.00 for up to 2 beds/booths, plus $20.00 for each additional bed/booth

(Do not mail cash)

Please make checks/money orders payable to: “BRHD”

Mail/deliver to: BRHD - Attention Heidi Johnson, 85 E. 1800 N., North Logan, UT 84341

As a condition of receiving a BRHD indoor tanning facility permit, I agree to comply (stay in compliance) with all tanning facility laws and regulations of the State of Utah and of the BRHD. I consent to periodic BRHD inspections of my facility. I understand that my BRHD permit to operate may be suspended or revoked for non-compliance with such laws and regulations.

Digital Signature

By typing your name below, you are signing this form electronically. You agree to, and understand, all the information you are submitting: