Change Of Use And/or Occupancy Form - East Goshen Township

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EAST GOSHEN TOWNSHIP
CHANGE OF USE AND/OR OCCUPANCY
1580 PAOLI PIKE. WEST CHESTER. PA 19380-6199
PHONE (610)-692-7171 FAX (610)-692-8950 Website
PLEASE PRINT
Please check applicable item(s) and complete sections noted.
Date Submitted: _______________________
 Residential
 Commercial
 Refinance only (complete sections 1, 2, 3, 8)
 Refinance only (complete sections 1, 2, 3, 8)
 Resale (complete sections 1, 2, 3, 4, 8)
 Resale (complete sections 1, 2, 3, 4, 8)
 Rental (complete sections 1, 2, 3, 5, 8)
 Rental/Lease/Tenant Change(complete sections 1,2, 3, 5, 8)
 Change of Use (complete sections 1, 2, 3, 5, 6, 7, 8)
_________________________________________________________________________________________________
1. PROPERTY INFORMATION:
___ ___ ___ - ___ ___ ___ ___ - ___ ___ ___ ___
Tax Parcel Number (TPN): 53 -
Zoning District: ___________
Property Address: ___________________________________________________________________________
Property Owner:
___________________________________________________________________________
Property Owner’s Address: _____________________________________________________________________
(If different than above)
Owner’s Phone Number: ___________________________ Fax Number: ______________________________
_________________________________________________________________________________________________
2. APPLICANT INFORMATION:
Applicant: _________________________________________________
_______________________________
Business Name/Property Owner
Individual Name or Contact Person
Address: _____________________________________ City: _______________ State: ____ Zip Code: ________
Applicant’s Phone Number: ______________________ 2nd or Alternate Phone Number: ____________________
Fax Number: _______________________ E-mail Address: ___________________________________________
_________________________________________________________________________________________________
3. PROPERTY CERTIFICATES:
REFINANCING: Does not require the Use & Occupancy Inspection. Please identify the property certificate(s) you are requesting below.
a) Resale/Rental Inspection: Certificate of Occupancy:
 Residential Property $ 60.00
 Commercial Property $ 150.00 per building
___________________________________________________________________________________________________________________________________________________________________________________________________
b) Sewer and Trash Certificate
 $ 5.00
___________________________________________________________________________________________________________________________________________________________________________________________________
c) Real Estate Tax Certificate
 $ 5.00
___________________________________________________________________________________________________________________________________________________________________________________________________
NOTE: Make THREE (3) separate checks payable to East Goshen Township labeled: 1) Resale or Rental Inspection, 2) Sewer and/or Trash
Certification; and 3) Tax Certification as noted above. Real Estate, Sewer & Refuse Certificates will be sent to the applicant identified in Section 2.
________________________________________________________________________________
4. RESALE INFORMATION:
New Owner’s Name: ________________________________________ Settlement Date: _____________________
CONTINUED ON NEXT PAGE
F:\Data\Shared Data\Code Dept\Application & Forms\Current Forms and Applications\Change of Use and or Occupancy Multi Use App 07012015.doc

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