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______________________________ 



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