RENTAL PERMIT APPLICATION

Community Development

Rental Permit Application

*A $75.00 fee is required for this inpection*

*Cash, Check or Money Order Only*
Name of Tenant:
Address to be inspected :
Email :
example@example.com
Phone:
Property Owners Name :
Mailing Address
City
State:
Zip
Email :
example@example.com
Phone:
Electric Company:
Account No:
Name on Account:
Gas Company:
Account No:
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 infonnation 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
Owner, Tenant, or Authorized Agent Signature:

Clear
***AN INSPECTION OF THE INTERIOR OF THE STRUCTURE IS REQUIRED***

***ACCESS MUST BE PROVIDED TO THE STRUCTURE***
Should be Empty: