Life Safety Division • City of Duluth Fire Department
615 West First Street • Duluth, MN 55802
Phone: 218-730-4380 • Fax: 218-730-5902
Email: lifesafety@duluthmn.gov • Website: www.duluthmn.gov/fire/
One Family Dwelling - Rental License Application Form
IMPORTANT: READ ALL INFORMATION ON BACK OF SHEET BEFORE APPLYING FOR RENTAL LICENSE
Property Address: _______________________________________________________________________
Number of Bedrooms:______________ Number of off street parking spaces provided:____________
Rental License Base Fee: $ 250.00
$25.00 Fee per Bedroom: ______ * $25.00 =
$100.00 Fee for Nonconforming Parking Spot: ______ * $100.00 =
Conversion Fee: $1,500.00
Make check payable to CITY OF DULUTH TOTAL DUE:
Contact Information: It is the sole responsibility of the license holder to maintain, and update this office IN
WRITING of all changes in your mailing address or phone number(s) to ensure all notices are received
promptly. WE ARE NOT RESPONSIBLE FOR UNDELIVERABLE MAIL OR NOTICES THAT RESULT IN THE LOSS OF
YOUR RENTAL LICENSE OR PENALITIES ISSUED AS A RESULT OF NONCOMPLIANCE ORDERS ISSUED.
Owner Information:
Name:______________________________________________________________________________
Address:____________________________________________________________________________
Cell Phone:_____________________________ Alternate Phone:_______________________________
Email Address:________________________________________________________________________
Manager Information (A local manager is required if owner does not live within 25 miles):
Name:______________________________________________________________________________
Address:____________________________________________________________________________
Cell Phone:_____________________________ Alternate Phone:_______________________________
Email Address:________________________________________________________________________
I hereby acknowledge that I have completed this application and state that the information contained therein is correct:
Signature of Owner/Manager:_______________________________________________ Date:____________________
NOTICE: The information provided in this application is a public record. Incomplete applications will not be accepted.
Falsified information may result in revocation of license.
