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Residential
Commercial
Mixed Use
Initial Registration
First Renewal
Second Renewal
Any Subsequent Renewal
De-Registration
Vacant
Abandoned
Under Construction
Occupied
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Off
On
Off
On
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Type Full Name :
Sign With Hand
Clear
Done
Initial Registration
Attachments
Email
*
Water
Agent Name
Address
First Renewal
Status
Block
*
Property Identified As
Any Subsequent Renewal
City, State, ZIP
Lienholder in Possession
Phone #
City, State, ZIP
I, the undersigned, hereby affirm that i am duly authorized to act on behalf of all ownership interests in the above-referenced property. I hereby attest/swear that the information contained herein is accurate and complete to the best of my knowledge. I am aware that if any of the foregoing statements made by me are willfully false, I am subject to punishment under the violations section of §132-91.le.
Property Type
*
Number of Stories
Name
Email
*
{[PNAME]}
$1000.00
Vacant Property Details
$1000.00
Phone Number
Company Name
Account Number
Certification
Fee Schedule
Assessment
Applicant Signature
*
Address
Number of Garages
Financial Institution/Bank Information
City, State, ZIP
*
Gas
Lot
*
Registration Fee
Address
*
Email
City, State, ZIP
*
Company Name
Phone #
*
Email
Company Name
Representative
*
Mailing Address
*
Name
*
Agent/Representative
Property Address
Address
*
Unit #
Second Renewal
Utilities
$1000.00
Phone #
Registration Type
*
$500.00
Phone #
*
Maintenance Company
Contact Agent
Electric
Date of Vacancy
*
Square Footage
Print Registration
Reference Number:
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