City:_______________________________
AgentName&Company:_____________________________________________________________________
Address:______________________________________________________________________
Fees:
Registration:$100PerRentalUnit
Inspection:$75PerRentalBiAnnual
Biannualrentalswillbecontactedforappointments.
NEWRENTAL:$75Inspection
NewRentalRequiresInspection.
BiannualInspectionrequiredforcurrentrentals.
ContactOfficeforNEWInspectionAppointments.
Trash:$165
One(1)trashunitisincludedintaxes,anyadditional
unitsarebilled@$165foreachadditionalunit.
Paybleto:BoroughofConshohocken
400 Fayette Street,Suite200
Conshohocken,PA19428
Phone:610.828.1092
Fax 610.828.0920
Iattestthatallinformationaboveisaccurate.
OwnerSignature:_______________________________________
Date:_________________________
PrintName:_______________________________________
OfficialUseBelow
EvenOddNewRentalRemove/Change Updated _____________
Initials
Owner'sMailingAddress:(allrequired)
Street:________________________________________________________________________
State:__________
Zip:_______________
POBoxesarenotaccepted
Tenant/Tenant'sName
&Phone#
#ofpeople&Check(√)
appropriatebox
Unit
#14yrsor
younger
#Over
age14
#
Handicap
REQUIREDIFYOULIVE
youareusinganagent,all
fieldsarerequired.
PropertyAddress:_____________________________________________________
CurrentRental
Owner'sName:________________________________________________________
NewRental
Doyouliveonsitethisrental
Owner'sphone#:__________________24HourPhone/Cell:___________________________
Email:_________________________________________________
City:_________________________________State:______________Zip:__________________
Phone#________________________________AfterHoursPhone#:______________________________
*
Note:Pleasefill inthehandicapboxifyoufeelthatpersonwouldneedassistanceinanemergency.
Lease
exp
date
Permit
Printed
Needs
Inspection
Email:____________________________________________
BOROUGH OF CONSHOHOCKEN
400 Fayette Street, Suite 200 Conshohocken, PA
19428 Phone (610) 828-1092 Fax (610) 828-0920
RENTAL PROPERTY REGISTRATION