Rev 3/2020
Principal Occupant’s Email:_______________________________
Phone:______________________________
City of Manchester
14318 Manchester Road
Manchester, MO 63011
P: (636) 227-1385 ex. 118
F: (636) 821-8099
pandz@manchestermo.gov
NAMES REQUIRED
Principal
Owner/Occupant
Head of Household
2
nd
Occupant
Relationship
3
rd
Occupant Relationship
4
th
Occupant Relationship
5
th
Occupant Relationship
6
th
Occupant Relationship
PROPERTY ADDRESS:__________________________________________________________________________
Owner:_______________________________________________________________________________________
Address:__________________________________________ Phone:__________________________________
City, State, Zip:_____________________________________ Email:__________________________________
Applicant:____________________________________________________________________________________
Address:__________________________________________ Phone:_________________________________
City, State, Zip:_____________________________________ Email:__________________________________
I hereby certify that the information contained in this application is correct, and that I will conform to all applicable laws
of the City of Manchester and complete the following Occupancy Information before the premises are occupied.
Principal Owner/Occupant
Signature:_________________________________________________________________Date:_______________
Printed:______________________________________________________________________________________
Inspected? Yes No Date of Inspection:___________________________
Fee paid on:______________________ Amount:___________________________
Single Family
Occupancy Permit
Application
OCCUPANCY INFORMATION: Occupancy Permit Fee: $25.00
Complete all requested information. List the names of all those who will occupy this residence and the relationships to
the Principal. Manchester City Ordinance does not allow more than three unrelated individuals to live in the same
residence (Section 405.060). Any missing or incomplete information may delay issuance of the occupancy permit.
No. of Bedrooms:_______________________________
Occupancy Limit:_______________________________
Rental Property? Yes No