Rental Inspection Property Notification
804-520-9297 / Fax 804-524-8755
RENTAL PROPERTY ADDRESS: ______________________________________
(Complete one form for each dwelling unit)
NAME: ________________________________
PHONE NUMBER: _________________
HOME ADDRESS: ____________________
_CITY: ____________________________
STATE: ________
ZIP: _________ E-MAIL ADDRESS: _____________________ ____
NAME: ________________________________
PHONE NUMBER: _________________
HOME ADDRESS: _____________________
_CITY: ____________________________
STATE: ________
ZIP: _________ E-MAIL ADDRESS: _____________________ ____
COMPANY NAME: _______________________________________
CONTACT NAME: _____________________________________________________
BUSINESS ADDRESS: ___________________________
CITY: ___________________________________
_STATE: ________ZIP: __________
PHONE NUMBER: ______________
______ FAX NUMBER: __________________
E-MAIL ADDRESS: ______________________________________________
Type of Dwelling: (Check One)
Single Family
Duplex Apartment If Apartments: Total Number of Units
The person signing this form acknowledges that this property is located within one of the
designated rental inspection districts. The owner or designated agent is responsible for scheduling
all inspections and meeting the inspection compliance dates within the time frames designated
unless prior arrangements are made through this office. The Building Inspections office should
be notified by letter should the property change from rental to owner-occupied or change from owner-
occupied to rental. We must also be notified if the property is sold.
Signature of Person Completing Form _____________________________________
Date ________________Owner Agent (check one)
Clear Form
Department of Planning & Community Development
Building Inspections Division
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