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1414 Evergreen, Wellston MO 63133
(314) 553 – 8000
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Occupancy Permit Application
Applicant's Information
Date
Name
Driver's License Number:
Social Security Number
Present Address
Telephone Number
Address of Property to Occupied
Apartment, suite, etc
City
State/Province
ZIP / Postal Code
Property Owner's Information
Name
Address of Property to Occupied
Apartment, suite, etc
City
State/Province
ZIP / Postal Code
Telephone Number
Social Security Number
Date of Birth
Please List the Names of All Persons Who Will Occupy the Property Listed Above
Name
Date of Birth
Social Security Number
Relationship to Applicant
Name
Date of Birth
Social Security Number
Relationship to Applicant
Name
Date of Birth
Social Security Number
Relationship to Applicant
Name
Date of Birth
Social Security Number
Relationship to Applicant
How many bedrooms are in the property you wish to occupy?
Total number of rooms in dwelling? (Do not include basement)
Type of heating?
Gas
Electric
Oil
Type of construction?
Brick
Frame
Type of building?
1
2
3
4
Family Dwelling
The above statements are true and correct to the best of my knowledge pursuant to Ordinance #225 and I understand that the dwelling I wish to occupy must be first inspected by the Environment Officer of the City of Wellston. After completion of inspection, if the building or dwelling prasses, the permit will be issued to the applicant.
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