CHANGE OF OCCUPANCY FORM

Community Development
Change of Occupancy Application
A $50.00 fee is required for this inspection*
Name of Business:
Address to be inspected:
Phone:
Contact Person
Phone:
Property Owners Name:
MailingAddress
State
State
Zip
Email:
example@example.com
Email:
example@example.com
Phone:
Electric Company:
Account
Name on Account:
Gas Company:
Account
Name on Account:
We only need natural gas account # if it has been turned off for 6 months or longer
CERTIFICATION AND AGREEMENT
Application is hereby made for an inspection to determine if the existing building described is in compliance with the City of Pearl Codes and Ordinances. I hereby certify that I have read this application and that all information contained herein is true and correct, and that I am the owner or authorized to act as the owner’s agent for this property.
Date:

Month Day Year
Date
Signature:

Clear
Owner, Tenant, or Authorized Agent

* An inspection of the interior of the structure is required*

*Access must be provided to the structure
Should be Empty:

Community Development