if applicant is a corporation or LLC)
(if different from applicant) - indicate "Same" if not different
If not affected property, please type "Not affected"
I hereby acknowledge my obligations and responsibilities pursuant to Chapter 95 and 197 of the City Code, a fair summary of which have been provided to the undersigned landlord or designated agent.
I hereby affirm under penalty of perjury that the information on this application, both for a rental facility license and with regard to lead poisoning prevention, is true to the best of my knowledge and belief. I also understand if there are any changes in property ownership, owner address or agent/contact information I will notify the Code Administration Office within 10 days of the change.
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