Request Form For Occupancy Certificate

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Request for Occupancy Certificate
It is requested that an inspection be made and an Occupancy Certificate be issued
for the structure built on Permit No._______________________ located at (street
address) _______________________________________ on (lot number)
__________________ on or after (date) _____________________________.
We understand that all Permit work (i.e. building, plumbing, electrical, heating, air
conditioning) must be complete. Provisions for a remote water meter readout device
is required. All residences shall have properly displayed thereon a number
corresponding to the street address. WATER METER MUST BE INSTALLED.
_______________________________________
(Owner-Agent)
_______________________________________
(Address)
Phone Number _____________________________
Zip Code _________________________

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