Change Of Use And/or Occupancy Form - East Goshen Township printable pdf download

EAST GOSHEN TOWNSHIP

CHANGE OF USE AND/OR OCCUPANCY

1580 PAOLI PIKE. WEST CHESTER. PA 19380-6199

PHONE (610)-692-7171 FAX (610)-692-8950 Website

PLEASE PRINT

Please check applicable item(s) and complete sections noted.

Date Submitted: _______________________

 Residential

 Commercial

 Refinance only (complete sections 1, 2, 3, 8)

 Resale (complete sections 1, 2, 3, 4, 8)

 Rental (complete sections 1, 2, 3, 5, 8)

 Rental/Lease/Tenant Change(complete sections 1,2, 3, 5, 8)

 Change of Use (complete sections 1, 2, 3, 5, 6, 7, 8)

_________________________________________________________________________________________________

1. PROPERTY INFORMATION:

___ ___ ___ - ___ ___ ___ ___ - ___ ___ ___ ___

Tax Parcel Number (TPN): 53 -

Zoning District: ___________

Property Address: ___________________________________________________________________________

Property Owner:

___________________________________________________________________________

Property Owner’s Address: _____________________________________________________________________

(If different than above)

Owner’s Phone Number: ___________________________ Fax Number: ______________________________

_________________________________________________________________________________________________

2. APPLICANT INFORMATION:

Applicant: _________________________________________________

_______________________________

Business Name/Property Owner

Individual Name or Contact Person

Address: _____________________________________ City: _______________ State: ____ Zip Code: ________

Applicant’s Phone Number: ______________________ 2nd or Alternate Phone Number: ____________________

Fax Number: _______________________ E-mail Address: ___________________________________________

_________________________________________________________________________________________________

3. PROPERTY CERTIFICATES:

REFINANCING: Does not require the Use & Occupancy Inspection. Please identify the property certificate(s) you are requesting below.

a) Resale/Rental Inspection: Certificate of Occupancy:

 Residential Property $ 60.00

 Commercial Property $ 150.00 per building

___________________________________________________________________________________________________________________________________________________________________________________________________

b) Sewer and Trash Certificate

 $ 5.00

___________________________________________________________________________________________________________________________________________________________________________________________________

c) Real Estate Tax Certificate

 $ 5.00

___________________________________________________________________________________________________________________________________________________________________________________________________

NOTE: Make THREE (3) separate checks payable to East Goshen Township labeled: 1) Resale or Rental Inspection, 2) Sewer and/or Trash

Certification; and 3) Tax Certification as noted above. Real Estate, Sewer & Refuse Certificates will be sent to the applicant identified in Section 2.

________________________________________________________________________________

4. RESALE INFORMATION:

New Owner’s Name: ________________________________________ Settlement Date: _____________________

CONTINUED ON NEXT PAGE

F:\Data\Shared Data\Code Dept\Application & Forms\Current Forms and Applications\Change of Use and or Occupancy Multi Use App 07012015.doc