HomeMy WebLinkAbout75 Mattachee paper application:+: '_ ll_-:
TOWN OF YARMOUTH
Health Department
1145 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664
Telephone (508) 398-2231 , ext. 124O
Fax (508) 760-3472
E-mail: epolite@ya rmouth. ma. us
bility to upload photos, and much more! This improved platform is designed to make your registration
xperience smooth and efficient.
hft ps://varmouthma.portal.openqov.com/
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Smoke Detectors and Carbon Monoxide Detectors are Required!
Owners: I have ensured the batteries are changed, have tested ALL Smoke Detectors/C
Monoxide Detectors and verified that they are leis than 1O years old: please initial -.1,Conlacl the Building Department regarding questions on type and tocalion prior to purchasi-ftI-
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A non-refundabte apptication fee of $80 pef UniUfgntal is required
Rental Certificates expire on December 31"r, 2024.
lf NOT registering online, please make checks payable to: Town of Yarmouth and mail compleled application &
payment to: Town of Yarmouth Health Department.
licatott and feeThe Health Depadtnent willcallto scliedule an inspection il rcquired, upotl receipt of your
Rental Property lnformation
All fields are re uired! lncom lete forms without a valid hone # or email cannot be rocessed
Rental Property Address
7{ i4 nrr*crled Rental Period:
/Annual Seasonalr/ Short Term (less than 31 days)
House/ Duplex Condo_ Apartment Room
Property Owner Name
Srn,yev /. l,q,la.s=Yo hnal*rr 4t &tua,.,t/? tonf
Mailing Address
(required)PrimEry Phone IIo
It,{- />O'V o>t--
Alternate Phone No (required)E-mail Atidres's
tt*ilfulocr, y'61,(butco
Owner's Representative/RentaT
Agent/Agency -t(t,rlt tyl 6.rl/0dd'-
Primary Phone No(o?-t9 - lqt /'(required)E-mail Address
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Furthermole, I understand I must notify the Health Department in writing when I am no longer renting the property, or I may besubject to rines and E€s
t/tlnDate/Sign
I have read and lbm lamillEi with the
Yarmouth Short Term Renla
for Human Habitation) allof
I Bylaw
which a
(l,z
Revised: 10/23/2023
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Application tor 2024 Rental Registration
Trash Removal by:
o*n", / Tenant
Rental of: