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Please provide us with additional information about the unit(s) you plan to rent: <br />Number of buildings: <br />Number of units: Efficiency 30 1 BR ` ) 5 2BR L 3+BR /Jk <br />Rent levels: Efficiency: $ - $�s, bcA <br />1BR: $ - $ C <br />2BR: $ - $ <br />3+BR: $ - $ <br />Do you currently accept Section 8 rental assistance vouchers? Yes No <br />NOTE: This information will be only used by City staff for tracking the status of rental housing in the City, and <br />will not be given out to the public without your consent. <br />Check here if you would like us to forward your contact information to individuals who contact the City looking <br />for rental housing: <br />The undersigned hereby applies for a rental dwelling License and acknowledges receipt of a copy of City Code Chapter 26; Article <br />XIV acknowledging the provisions of the Rental Residential Dwelling Units Code have been reviewed; and attests the subject <br />premises will be operated and maintained according to the requirements contained therein, subject to applicable sanctions and <br />penalties The undersigned further agrees the subject premises may be inspected by the compliance official as provided in City <br />Code Chapter 26; Article XIV; Sec. 26-650 of said ordinance. The undersigned hereby certifies that the above information is true <br />and correct to the best of their knowledge: <br />Applicant Signature: <br />00004 <br />Date: 8 t4I tit <br />For City Use Only <br />DATE RECEIVED: i (ill (`r <br />ZONING: R- a /Y1 eQ . j <br />DATE APPROVED BY CC: <br />INSPECTION DATE: <br />REINSPECTION DATE (if needed): <br />RENEWAL DATE: <br />'-1 UVl t +5 <br />