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3330 SOUTH 1300 EAST Millcreek, Utah 84106 [PHONE REDACTED] Millcreek.us Rental Property Address: Property Owner Name: Number of Adult Tenants: Owner Address: Owner Phone: Number of Bedrooms: Number of On-Site Parking Spaces: All the following are required for each rental unit: No more than four unrelated persons will occupy this unit Smoke detectors are installed in each sleeping room, in each hallway, and there is at least one on each floor including basement Handrail is installed for each stairway of 4 steps or more Emergency egress window is available in each sleeping room. The bottom of each egress window shall be less than 44 inches above floor with a clear openable area of more than 24 inches high and more than 20 inches wide, or built to the adopted Building Code of the year the house was originally constructed Functioning bathroom (sink, toilet, bathing facility) and kitchen (sink, stove) is provided Functioning furnace that delivers a minimum of 68 degrees Fahrenheit is provided Fire extinguisher is provided in each kitchen Guardrail at least 36 inches high is installed at each deck, balcony, or porch that is 30 inches or higher above ground Safety glass is installed at each shower or bathtub, or exempt if no glass enclosures exist Ground-Fault Circuit Interrupters (GFCI) protected receptacles (plugs) are installed in each bathroom and at kitchen counter receptacles, or receptacles installed to the adopted Electrical Code of the year the house was originally constructed This rental unit is safe and sanitary and well maintained and, the plumbing, electrical, and HVAC systems are in working order and safe Landscaping will be maintained in good condition (not applicable to condominiums) Public sidewalks (if existing) will be kept clear from overgrowth and snow (not applicable to condominiums) Address is clearly visible from the street (not applicable to condominiums) I certify under criminal penalty of perjury under Utah law that all the above stipulations are met respecting this rental unit. I also understand that a Business License inspection may be performed by a Millcreek Inspector and I agree to accommodate such upon reasonable notice as a condition of that license. Authorized Signature: Name Printed: Date: