2. 
4. Application for Residential Rental Permit
6. Address of Rental Property*
8. Property Owner's Name*
10. Property Owner's Address
12. Property Owner's Phone#
13. Property Owner's Cell#
14. Property Owner's Email Address
16. Agent's Name (If applicable)
18. Agent's Address
20. Agent's Phone#
21. Agent's Cell#
23. Is this a new owner?*

    1. Yes
    2. No
25. Type of Rental?*

    1. Single-Family
    2. Two-Family
    3. Multi-Family (3 or more)
    4. Boardinghouse
27. Number of Rental Units*
29. Any Units Owner Occupied?

    1. Yes
    2. No
30. If so, which one?
32. Who should be notified if any of the tenants are delinquent on utilities?

    1. Owner
    2. Agent
34. Who should be notified about rental permit renewals and rental inspections

    1. Owner
    2. Agent
36. Who should be notified about code violations

    1. Owner
    2. Agent
40. I hereby verify that the information provided on this application is true and correct and to the best of my knowledge and information. I hereby affirm to abide by and adhere to the Code of the Borough of Ephrata and any and all applicable Federal or State laws, statutes or regulations.
42. Pursuant to the Code of the Borough of Ephrata, the owner of a property shall be liable along with the tenant for the payment of utility services supplied to the leased premises and for all damages occurring because of the leasee’s misuse of utility service and/or equipment.
44. The required payment of this permit acknowledges that as owner of this property you accept responsibility for the following: • Marking all water and electric meters to correspond with the appropriate apartment number or letter. • Notifying the Borough Business Office (717-738-9222) when there is a change in occupancy to verify the moving date. • Payment of utility bills while the property is vacant between tenants. • Payment of utility services supplied to the leased premises on the property if the tenant defaults. • Damages occurring because of the tenant’s misuse of the utility service and/or equipment.
46. Name*
    By entering your name and date above, you are signing this form and agreeing to all terms and conditions of this application.
47. Date*
    Date
Leave This Blank:


51. 1. Receive an email copy of this form.
52. Email address

    This field is not part of the form submission.

53. Submit Submit and Print

* indicates a required field