This type of retail location typically sells a wide variety of products so that the sale of tobacco products* accounts for less than 35% of the total quarterly gross receipts.
In addition, less than 20% of the retail floor space and less than 20% of the total shelf space is allocated to the offer, display or storage of tobacco products.
There is no self-service display for tobacco products.

I understand that in order to be permitted as a General Tobacco Retailer, the business identified in this application may not at any time:
Have any self-service display of tobacco products; or
Have 20% or more of the total retail floor space allocated to the offer, display, or storage of tobacco products; or
Have 20% or more of the total shelf space allocated to the offer, display, or storage of tobacco products; or
Have 25% or more of total quarterly gross receipts from the sale of tobacco products.
Have the name of business evidences holding itself out as a tobacco Specialty Business; e.g., "Smoke Shop", "Vape Shop", etc. as opposed to "Tommy’s Trinkets" or Nonie’s Notions";

This type of retail location typically specializes in the sale of tobacco products*
25% or more of the total quarterly gross receipts are from the sale of tobacco products, or;
20% or more of the retail floor space is allocated to the offer, display, or storage of tobacco products, or;
20% or more of the total shelf space is allocated to the offer, display, or storage of tobacco products, or;
the retail space features a self-service display for tobacco products.

I understand that in order to be permitted as a Retail Tobacco Specialty Business, the business identified in this application may not at any time, be within:

1) 1,000 feet of a community location**; or
2) 600 feet of another retail tobacco specialty business; or,
3) 600 feet of property used or zoned for agricultural or residential use.

I further understand, and my signature binds all proprietors for the business listed on this application, that if any requirements for a Retail Tobacco Specialty Business are violated, this permit may be revoked by the issuing health department.

A map of the proposed retail tobacco specialty business location is attached that shows the location of any community location**, other retail tobacco specialty business, agricultural or residential property. The tobacco specialty application cannot be processed without the map.

Attach a copy of the store's current tax commission tobacco license. The application cannot be processed without a current license.

Payment must be submitted with the application. No permit will be issued without the payment of the permit fee. A plan review will not be conducted until payment of the plan review fee. It is the responsibility of the applicant to verify zoning and proximity restrictions. Fees cannot be refunded if it is later determined that the identified location does not meet zoning or proximity requirements.

New Permit: $30.00
Permit Renewal: $20.00 (not an option until after June 30, 2019)
Permit Reinstatement: $30.00
Retail Tobacco Specialty Business Plan Review: $250.00 (required for all new retail tobacco specialty business permit applications)

I certify that the information provided is true and accurate to the best of my understanding. I understand that any incorrect information may result in the suspension or revocation of the health department’s tobacco permit. I also understand that the health department may recommend to the business licensing entity that the business license be suspended or revoked. Any such action will be reported to the Utah State Tax Commission.

If the information required in this application changes a tobacco retailer may not renew their permit and must apply for a new permit no later than 15 days after the information changed.

By clicking submit I am signing this application and my signature binds all proprietors for the business listed on this application to the above agreements.