HomeMy WebLinkAboutRental ApplicationRental Property Information
JAN 0 6 2025
EALTH DEPT
All fields are required! Fot'ms without o volid phone #, addrcss, or e-ntoil oddress will not bc processecl
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Rental Property Address Rental Period:
ear-Round/Lonp Term \1,*
eekly/Short Term (less than 31 days) _
ner- Tenant X
1'rash Removal by
H ouse_ Duplex{ Condo_ Aparttlelrt_ Roorr_
Rental of
roperty Owner Full Name:llt r"te p.,rdJ LL(
requ ired ) Enrirc MailinB Address:
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Prinrary PhoDe N unrber:
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(requ iretl Alterrate l)h<lne Nuntber (req uired) E-mail Address
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N ad o h f
Representative's Primary phone
Number:
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Furthermore, I understand I must noti8, the Health Departmert ir writint when I anr no tonger renting theproperty, or I may be subiect to fines & fees.
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11/26/2024
Please Print Clearly
Mar,DelVacatiorl,
Representative's E-mail Address:
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Please Print Clearly
Rental Propertv Inf0r.matio0
Rental Property Add ress:
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Rental Period:
ear-Round/Long'l'erm Y__
eekly/Short Term (less tian 3l days)
-_Trash Removal by
wner Tenant X House_ Duple{ Coudo_ Aparrtrrent_ Room_
Rental of
/it r"te ?lvtr*J r.c(
roperty Owner Full Name req uired ) Entire Mailing Address:
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'lic^^Yi...r* ia<Dt
rimary Phone Number
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(rcr1rired) P Alternate Phone Number:(required) E-mail Address:
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Reprcsentiitive's E-mail Address
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Represen tat,ve s Primarv Phone
N unrbet:
Furthermore, r understand l must notify the Hearth Depanment in writing when r am no ronger renting theproperty, or I may be sub,ect to fines & fees.
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Re''a 11/26/2024
JAN 0 n 2025
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