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2. 

3. City of Ellisville

   1 Weis Avenue

   Ellisville, Missouri, 63011

   Phone: 636-227-9660  *  Fax: 636-227-9486

   
   

   OCCUPANCY PERMIT FOR RESIDENTIAL USE

5. Date:*
   Date:

6.  

7. Permit #:

9. PERMIT FEE IS BASED ON THE SQ. FT. OF TOTAL LIVING SPACE. $1 PER 100 SQ. FEET WITH A MIN OF $25

   CASH / CHECK / CREDIT CARD

   
   

   A Permit is requested for those named below to occupy the premises known as:

11. Address:*
13. Apt. #
14. City*
15. State*
16. Zip*
18. Occupant's Name:*
19. Phone #:*
21. Spouse's Name:
22. Phone #:
24. Email Address:*

26. CHILDREN WHO WILL OCCUPY THE UNIT (FIRST AND LAST NAMES):

28. Name:
29. Age:
31. Name:
32. Age:
34. Name:
35. Age:
37. Name:
38. Age:
40. Name:
41. Age:

43. NAMES OF OTHER PERSONS WHO WILL OCCUPY THE PREMISES:

45. Name:
46. Relationship:
48. Name:
49. Relationship:

51. PETS OCCUPYING PREMISES:

53. Dog(s) How Many:
54. Breed(s)
56. Cat(s) How Many:
57. Breed(s)

61. IF YOU ARE RENTING, PLEASE FILL OUT THE NEXT SECTION, IF NOT, DISREGARD THIS SECTION AND PROCEED.

65. Owner's Name:
66. Owner's Phone #:
68. Owner's Address:
70. Owner's City:
71. Owner's State:
72. Owner's Zip:
74. Manager or Agent Name:
75. Phone #:
77. Address:
79. City:
80. State:
81. Zip:
83. Email Address:
87. Total Square Footage of Property:*
88. Bedrooms #:*
89. Bathrooms #:*
90. Proposed Occupancy Date:*
    Proposed Occupancy Date:

92. I certify that I am the owner/occupant or agent of the premises described in this application and that the answers contained herein are true and accurate in all aspects to the best of my knowledge.

94. Signature of Owner/Occupant or Agent:*

96. Ver: 12/05/2023

Leave This Blank:


97. 1. Receive an email copy of this form.
98. Email address

    This field is not part of the form submission.

99. Submit

* indicates a required field