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2. APPLICATION FOR CERTIFICATE OF OCCUPANCY

   CITY OF FAIRBURY

   OFFICE OF THE CODE ENFORCEMENT OFFICIAL

4. Street Address of Propery(ies) to Be Maintained As A Rental Unit (the "Property"), and Number of Rental Units:

6. ADDRESS
7. # OF UNITS
8. FOR OFFICE USE ONLY

   Exemption/Reason for Exemption

10. ADDRESS
11. # OF UNITS
12. FOR OFFICE USE ONLY

    Exemption /Reason for Exemption

14. ADDRESS
15. # OF UNITS
17. ADDRESS
18. # OF UNITS
19. FOR OFFICE USE ONLY

    Exemption /Reason for Exemption

21. ADDRESS
22. # OF UNITS
23. FOR OFFICE USE ONLY

    Exemption /Reason for Exemption

25. ADDRESS
26. # OF UNITS
27. FOR OFFICE USE ONLY

    Exemption /Reason for Exemption

29. ADDRESS
30. # OF UNITS
31. FOR OFFICE USE ONLY

    Exemption /Reason for Exemption

33. Name of Owner of Property (the "Owner"):
35. Address of Owner:
37. Phone Number of Owner:
38. Cell Phone Number of Owner:
40. Name of Owner's Agent (if applicable):
42. Address of Owner's Agent (if applicable):
44. Phone Number of Owner's Agent:
45. Cell Phone Number of Owner's Agent:

47. Owner does hereby request a Certificate of Occupancy from the City of Fairbury Code Enforcement Authority for the purposes of maintaining a Rental Unit within the City's jurisdiction that is owned by the Owner, pursuant to the City's Rental Code. Owner is paying with this application $50.00 for initial Rental Unit, plus $10.00 for each additional Rental Unit the Owner seeks to rent.

49. Owner
50. Date

52. Form B

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54. 1. Receive an email copy of this form.
55. Email address

    This field is not part of the form submission.

56. Submit Submit and Print

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