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West Valley City Pet Exception Permit

2. West Valley City Pet Exception Permit
   This form is to request a pet exception permit from West Valley City Animal Services. Per code 23-3-108, a permit can be issued to allow up to four dogs or cats (not more than four household pets) in a residential area, provided: The owner completes the application and pays all associated fees; All Dogs and Cats at the address are rendered sterile; All Dogs and Cats at the address are microchipped; Adequate areas for confinement and shelter are provided; and The owners have not been found in violation of this Title or Title 76, Chapter 9, Part 3, Utah Code Annotated 1953, within the past 12 months.

   This form is to request a pet exception permit from West Valley City Animal Services. Per code 23-3-108, a permit can be issued to allow up to four dogs or cats (not more than four household pets) in a residential area, provided: The owner completes the application and pays all associated fees; All Dogs and Cats at the address are rendered sterile; All Dogs and Cats at the address are microchipped; Adequate areas for confinement and shelter are provided; and The owners have not been found in violation of this Title or Title 76, Chapter 9, Part 3, Utah Code Annotated 1953, within the past 12 months.

4. Applicant Information:

5. West Valley City Residents Only

7. First Name*

8. Last Name*

10. Address1*

11. Apartment #

13. Address2

14. Apartment #

16. City*

17. State*

18. Zip*

20. Email Address*

22. How long have you lived at the address listed above? *

23. Have you or anyone who lives at the address listed above ever been convicted of a crime or violation of a City or State animal ordinance?*

    1. NO
    2. YES

25. Phone Number*

26. Alternate Phone Number

28. Email Address*

29. Please attach a photo of your government issued ID*

31. How many pets live at the above address?*

32. What types of pets live in the home?

34. Animal Information:

35. Following information is required for each pet: Proof of sterilization, proof of current rabies vaccination, and proof of microchip. If your pet is not currently microchipped, there is an option to purchase microchip at time of licensing.

37. Pet # 1

39. Pet Type*

    1. DOG
    2. CAT

40. Pet's Name*

41. Age*

42. Breed*

44. Color*

45. SEX*

    1. FEMALE
    2. MALE

46. Has your pet been spayed/neutered?*

    1. YES
    2. NO

47. Please attach spay or neuter certificate*

49. Does your pet have a microchip?*

    1. YES
    2. NO

50. Please attach proof of microchip/microchip number*

51. Would you like us to microchip your pet for $10 at the time of licensing?*

    1. YES
    2. NO

53. Is your pet current on a rabies vaccination*

    1. YES
    2. NO

54. Please attach a current rabies certificate*

55. Is this pet currently licensed with West Valley City?*

    1. YES
    2. NO
    3. UNKNOWN

56. Do you have another pet?*

    1. YES
    2. NO

60. Pet #2

62. Pet Type*

    1. DOG
    2. CAT

63. Pet's Name*

64. Age*

65. Breed*

67. Color*

68. Sex*

    1. FEMALE
    2. MALE

69. Has your pet been spayed/neutered?*

    1. YES
    2. NO

70. Please attach spay or neuter certificate*

72. Does your pet have a microchip?*

    1. YES
    2. NO

73. Please attach proof of microchip/microchip number*

74. Would you like us to microchip your pet for $10 at the time of licensing? *

    1. YES
    2. NO

76. Is your pet current on a rabies vaccination*

    1. YES
    2. NO

77. Please attach a current rabies certificate*

78. Is this pet currently licensed with West Valley City?*

    1. YES
    2. NO
    3. UNKNOWN

79. Do you have another pet?*

    1. YES
    2. NO

83. Pet #3

85. Pet Type*

    1. DOG
    2. CAT

86. Pet's Name*

87. Age*

88. Breed*

90. Color*

91. Sex*

    1. FEMALE
    2. MALE

92. Has your pet been spayed/neutered?*

    1. YES
    2. NO

93. Please attach spay or neuter certificate*

95. Does your pet have a microchip?*

    1. YES
    2. NO

96. Please attach proof of microchip/microchip number*

97. Would you like us to microchip your pet for $10 at the time of licensing? *

    1. YES
    2. NO

99. Is your pet current on a rabies vaccination*

    1. YES
    2. NO

100. Please attach a current rabies certificate*

101. Is this pet currently licensed with West Valley City?*

     1. YES
     2. NO
     3. UNKNOWN

102. Is there another pet?*

     1. YES
     2. NO

106. Pet #4

108. Pet Type*

     1. DOG
     2. CAT

109. Pet's Name*

110. Age*

111. Breed*

113. Color*

114. Sex*

     1. FEMALE
     2. MALE

115. Has your pet been spayed/neutered?*

     1. YES
     2. NO

116. Please attach spay or neuter certificate*

118. Does your pet have a microchip?*

     1. YES
     2. NO

119. Please attach proof of microchip/microchip number*

120. Would you like us to microchip your pet for $10 at the time of licensing? *

     1. YES
     2. NO

122. Is your pet current on a rabies vaccination*

     1. YES
     2. NO

123. Please attach a current rabies certificate*

124. Is this pet currently licensed with West Valley City?*

     1. YES
     2. NO
     3. UNKNOWN

128. Please Note:
     If your permit is approved, a staff member will contact you to set up an appointment to pay for licensing and sign the permit agreement. Any denied applications will be notified by a letter in the mail. Please be aware that filling out the application does not guarantee a permit will be issued.

     If your permit is approved, a staff member will contact you to set up an appointment to pay for licensing and sign the permit agreement. Any denied applications will be notified by a letter in the mail. Please be aware that filling out the application does not guarantee a permit will be issued.

130. By signing below, you agree that all answers above are true and complete.

132. Electronic Signature*

133. Date*
     Date

Leave This Blank:


135. 1. Receive an email copy of this form.
136. Email address

     This field is not part of the form submission.

137. Submit

* indicates a required field