BENSALEM TOWNSHIP
Building and Planning Department
2400 Byberry Road Bensalem, PA 19020
215-633-3644 ▪ Fax 215-633-3753
RESIDENTIAL RENTAL - USE & OCCUPANCY PERMIT
APPLICATION
To lease and occupy a rooming unit, rooming house, hotel, motel, apartment, multi-family, condominiums
and residential dwelling either new use or through new tenants as in the case of a leased property.
CURRENT PROPERTY OWNER LESSEE
Name
Address
Email
Phone No.
REALTOR MANAGER
Name
Address
Email
Phone No.
MOVE-IN DATE:
SITE INFORMATION
Location of Subject Property
Street Address (house, building, and/or unit number)
Tax Parcel Number:
Unit Type (please check)
Apartment Multi-family dwelling unit
Single-family dwelling Rooming unit
Important: All applications must comply with all Building Codes and Bensalem Township Ordinances. Checks
should be payable to “Bensalem Township”.
Signature Date
A SIGNED COPY OF THIS APPLICATION IS REQUIRED PRIOR TO ISSUANCE OF PERMIT
jmr 5/2016
Permit No.
Date:
Fee:
