City of edmundson application for residential inspection and occupancy permit
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CITY OF EDMUNDSON APPLICATION FOR RESIDENTIAL INSPECTION AND OCCUPANCY PERMIT
Date:_________________________ Inspection Scheduled for: _____________________________
I hereby request permission to occupy_________________________________________________(address). In the City of Edmundson, a dwelling unit or apartment on __________________________________(date).
NAME:__________________________________________________________SS#_________________________ DOB:___________________OLN#___________________________________Phone_______________________
Name of Spouse:________________________________________________SS#__________________________ DOB:___________________OLN#________________________________________________________________
CHILDREN OF HOUSEHOLD (NATURAL/ADOPTED/STEP-CHILDREN) NAME:______________________________________DOB:___________________SS#_____________________ NAME:______________________________________DOB:___________________SS#_____________________ NAME:______________________________________DOB:___________________SS#_____________________ NAME:______________________________________DOB:___________________SS#_____________________
ALL OTHER PERSON WHO WILL OCCUPY THE DWELLING NAME:______________________________________DOB:___________________SS#____________________ NAME:______________________________________DOB:___________________SS#____________________ NAME:______________________________________DOB:___________________SS#____________________ Name, address and phone number of Real Estate Agency/Owner/Other_____________________________ ____________________________________________________________________________________________ I CERTIFY THAT I AM THE PROPOSED OCCUPANT AND THAT THE ANSWERS CONTAINED HEREIN ARE TRUE AND ACCURATE IN ALL RESPECTS TO THE BEST OF MY KNOWLEDGE AND BELIEF: Signature of Applicant: _________________________________________Date_________________________ Fees paid on _______________________________________________________________________________ Inspection passed on ________________Bldg Inspectors Signature:________________________________ Permit issued on ____________________________Occupancy Number______________________________ Download 6.86 Kb. Do'stlaringiz bilan baham: 
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