1
Sh
ort-Term Rental Permit:
Owner’s Affidavit
Please read and initial your understanding of each condition
_______ Only a short-term rental operator shall operate the short-term rental.
_______ The short-term rental operator shall reside on the premises 185 days per year
_______ A maximum of five (5) sleeping rooms are permitted.
_______ A maximum of two (2) persons over the age of 18 shall occupy each sleeping
room.
NOTE:
The Virginia Uniform Statewide Building Code (VUSBC) may reduce
occupancy.
_______ At least one person in the short-term renter party shall be 18 years of age or
older.
_______ No short-term rental may have more than one booking transaction for the same
date.
_______ The Short-Term Rental Permit Number shall be displayed on all advertisements.
_______ No short-term rental operator shall offer, allow, provide, or advertise a short-term
rental for any commercial use not customarily incidental, including, but not limited
to, the use for parties, banquets, weddings, meetings, filming, advertising activities,
or any gathering of persons other than the authorized short-term renter.
FLOOR PLAN REQUIREMENTS
(MUST BE DRAWN TO SCALE OR PROVIDE DIMENSIONS)
(INITIAL BY EACH)
_______ Use of each room
_______ Occupancy level of sleeping room(s)
_______ Location and dimension(s) of door(s) and/or window(s)
_______ Location of Carbon Monoxide Detector(s)
_______ Location of Fire Extinguisher(s)
_______ Location of smoke detector(s)
TO BE COMPLETED BY THE APPLICANT
SHORT-TERM RENTAL OPERATOR NAME:
PRIMARY RESIDENCY ADDRESS:
SHORT-TERM RENTAL OPERATOR EMAIL ADDRESS:
SHORT-TERM RENTAL OPERATOR PHONE NUMBER:
2
Short-Term
Rental Agreement:
THIS AGREEMENT, entered into this ___________ day of, ______________, 20 , by and
between The Zoning Administration Office of the City of Richmond and
_________________________ (owner), who is responsible for and controls the real property
located at _____________________________________ (Tax Map: _________________ ), in the
City of Richmond, Virginia, hereinafter referred to as, ”Responsible Party”.
W I T N E S S E T H :
The “Responsible Party” understands, agrees and stipulates that the conditions set forth
will be met. This waiver is voluntarily and freely made with the full knowledge of its
effect and consequences.
The “Responsible Party” also consents and agrees that the Zoning Administrator or his
duly authorized agent(s) may enter the property, on reasonable notice to the
“Responsible party”, for the purposes of determining compliance with the subject Short-
Term Rental Permit and take such action as may be necessary to bring about complete
conformance with all terms and conditions of this agreement.
This Agreement shall be interpreted in accordance with laws of the State of Virginia.
This is a fully integrated Agreement and contains the entire Agreement between the
parties. Any prior written or oral Agreements that are different in terms, conditions and
provisions of this Agreement shall be of no effect and shall not be binding upon either
party unless referred to herein.
No amendment or modification at this Agreement shall be valid unless expressed in
writing and executed by the parties hereto in the same manner as the execution of this
Agreement.
BY: ___________________________________________
(Print Name)
OWNER: ___________________________________________
(Signature)
click to sign
signature
click to edit
3
Short-Term Rental Permit:
Primary Residency Documentation
Primary Residency Requirement
Ordinance No. 2019-343 requires that a short-term rental shall be on the lot of the
operator’s primary residence with the operator occupying the lot at least 185 days
each year.
To provide verification of primary residency at the property, please provide:
Two (2) documents from the primary list; and,
Two (2) documents from the primary or secondary list
Original documents must show your name and the address of your current
residence as it appears on the application.
Primary Proof of Residency Documents
Virginia current driver or commercial driver license displaying the current
address
DMV-issued ID card displaying the current address
Employer payroll check stub issued within the last two months
Social security statement for the current calendar year
Internal Revenue Service W-2 tax form not more than 12 months old
Secondary Proof of Residency Documents
Virginia voter registration card mailed to you by your local registrar
Current automobile insurance bill (cards or policies are not accepted)
Certified copy of school records/transcript or official report card issued within the last
year (online courses not accepted)
Monthly bank or credit card statement not more than two months old
Receipt for personal property taxes paid within the last year to the Commonwealth of
Virginia or a Virginia locality
Medical or dental bill issued within the last two months
Official correspondence from a governmental agency displaying the applicant’s name
and current address (DMV issued documents without postmarked envelopes are not
accepted)
Credit report issued to the applicant issued within the past 6 months
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome