Borough of Wilkinsburg
Code Enforcement
Municipal Building
605 Ross Avenue
Wilkinsburg, PA 15221
Phone: (412) 244-2923 Fax: (412) 244-2922
TENANT REGISTRATION APPLICATION
Date ________________________ Application # __________________________
TYPE OF REGISTRATION ANNUAL CHANGE OF TENANT CHANGE OF OWNERSHIP
Property Address ___________________________________ Usage: Comm. Res. Mixed
Property Owner Name____________________________________ Lot & Block #_______________________
Owner’s Address___________________________ City _____________________St_______ Zip_________
Phone-Home ___ Phone Cell _____________________ Fax _______________________
Email Address________________________________________________________
Emergency/Management Contact____________________________________________________________
Emergency/Management Address__________________________ City ______________St____ Zip_________
Phone-Home ___ Phone Cell _____________________ Fax _______________________
Email Address________________________________________________________
Fees $ 10.00 per unit TBC
Please print clearly. Illegible and incomplete forms will not be accepted. Please remit payment with this
application. For Corporations, a form of identification of an authorized officer of the company, or copy of a
written agreement of the corporation’s registered agent is required.
The undersigned hereby represents that, to the best of his/her knowledge, belief that all information listed
above is true, correct, and complete; and that all attachments contain the required information.
Applicant Signature
Print Name: ___________________________________________
Signature: ____________________________________________ Date: ______________
For Office Use Only
Permit Number __________
Fee Paid $ ______________
Approved By: __________________________________________ Date: __________
Title: _________________________________________________
Modified 04/28/2017
