Form 81-900 (1) - License Application Housing Inspection
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4WHEN COMPLETED, MAIL TO:
CITY OF PHILADELPHIA • DEPARTMENT OF LICENSES AND INSPECTIONS
DEPARTMENT OF LICENSES AND INSPECTIONS
LICENSE APPLICATION
CUSTOMER CARE UNIT, PUBLIC SERVICE CONCOURSE
1401 JOHN F. KENNEDY BOULEVARD
HOUSING INSPECTION
PHILADELPHIA, PA 19102-1687
USE A SINGLE CHECK OR MONEY ORDER FOR ALL FEES,
Follow Instructions listed on Instruction Sheet
PAYABLE TO "CITY OF PHILADELPHIA"
For further information call (215) 686-8686
1. Address of Property
City
State
ZIP Code
2. Name of Owner/Operator (First, Last)
3. Owner/Operator's Address (P.O. box not acceptable)
City
State
ZIP Code
4. Philadelphia Business Income and Receipts Tax Number
5. Philadelphia Commercial Activity License Number
6. Name of Agent (if applicable)
7. Agent's Address (must be a Philadelphia street address)
City
State
ZIP Code
8. Contact (person responsible for receiving communication, violation notices, etc.)
AGENT
OWNER / OPERATOR
9. Contact Daytime Telephone No.
Contact Evening Telephone No.
10. Contact FAX No.
11. Contact E-Mail Address
12. LICENSE TYPE
LIC. FEE
LIC. CODE
EXPIRATION DATE
LICENSE NUMBER
HOUSING INSPECTION LICENSE
$ 50.00 per unit
3202
FEBRUARY 28
VACANT PROPERTY/LOT LICENSE
$ 150.00
3219
FEBRUARY 28
CHANGE OF REQUIRED INFORMATION
No fee required.
If the number of units change in a licensed property or the owner, agent, or address information
changes at any time, a new application must be submitted within 30 days. Failure to do so will result in
the revocation of the license.
13. License Fee Calculation
a) Total Rental Units*
x $ 50. 00
=
(Maximum Fee: $ 20,000.00)
b) Vacant Property/Lot
+
c) Total License Fee
=
* Owner occupied duplex is considered one (1) rental unit for the purpose of calculations. Check here if claiming exemption:
PLEASE BE SURE TO READ AND COMPLETE THE OTHER SIDE OF THE APPLICATION
81-900 (1) (Rev. 12/12)
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