Occupancy Permit

2. 
4. City of Maplewood, MO Occupancy Permit
6. Please indicate the type of occupancy permit.*

   1. New Occupancy Permit
   2. Change to Existing Occupancy Permit
8. Please indicate the type of unit you will be occupying.*

   1. Rental
   2. Owner-Occupied
10. I hereby request permission to occupy:
12. Address*
14. Apartment No.
16. Applicant's Name:*
18. DOB:*
19. Phone Number:*
21. Place of Employment:
22. Work Phone:
24. Work Address:
26. E-mail Address:*
28. Occupancy Status*

    1. I am the only occupant
    2. There are additional occupants
30. Spouse/Partner Name (if occupying unit):
    PLEASE NOTE: Each field must be completed for spouse/partner or the application will not be considered complete.
32. Spouse/Partner DOB:
34. Spouse/Partner Place of Employment:
35. Spouse/Partner Work Phone:
36. Spouse/Partner Work Address:
38. Please email a copy of your photo ID to occupancypermit@cityofmaplewood.com. Anyone 18 years of age or older that will be residing in the unit must also submit a photo ID. Valid forms of ID include a driver's license, passport, or state issued ID. This must be provided in order to process the application.
40. Please provide first & last names of children (if occupying unit).
42. Child #1 Name:
43. Child #1 DOB:
45. Child #2 Name:
46. Child #2 DOB:
48. Child #3 Name:
49. Child #3 DOB:
51. Please provide first & last names of other persons who will be occupants of unit.
53. Name:
55. Relationship:
56. DOB:
58. List total number who will occupy the unit.
    “Compliance with occupant load limits is determined solely by the number of occupants without consideration of “familial status” as defined in the Fair Housing Act 42 U.S.C.A Section 3602(k).”:
60. Will you have any animals occupying the premises?*

    1. No
    2. Yes
62. What kind of animals will you have?
    -- Select One --Please List Any Pets You HaveCat(s)Dog(s)OtherNone
64. How many animals?
    -- Select One --Please List Number of AnimalsOne DogTwo DogsOne CatTwo CatsOne Dog and One CatNumber of Animals Exceeds Maplewood's Allowable Limit, I am contacting Public Works Staff.None

    Any dog or cat in the City of Maplewood is required to have a pet license. The City of Maplewood Code permits no more than two animals (dogs, cats) per household. If you have more than the allowable number, you will need to get a Kennel License. If you have chickens, you will need a special permit. Please call Public Works at 314-645-3600 for more information.
66. Name of Owner / Agent:
67. Owner / Agent Address:
68. Owner / Agent Phone Number:
70. How would you like to receive the Maple Leaf Newsletter? *

    The Maple Leaf is distributed twice a year, in the Spring/Summer and Fall/Winter. If you choose to receive the Maple Leaf electronically you need to sign up at www.cityofmaplewood.com/notifyme

    1. I would like a copy mailed to my home address.
    2. Please remove my address from the mailing list. I prefer to receive an electronic copy of the newsletter.
72. Please email a copy of your photo ID to occupancypermit@cityofmaplewood.com. Anyone 18 years of age or older that will be residing in the unit must also submit a photo ID. Valid forms of ID include a driver's license, passport, or state issued ID. This must be provided in order to process the application.
74. I certify that I am the proposed occupant, and that the answers written here are true and accurate in all respects to the best of my knowledge.*

    1. Agree
    2. Disagree
76. I REPRESENT THAT THE INFORMATION PRESENTED ON THIS FORM IS TRUE AND ACCURATE IN ALL RESPECTS. I UNDERSTAND THAT ONLY THOSE INDIVIDUALS LISTED ON THE OCCUPANCY PERMIT ARE LAWFULLY ALLOWED TO OCCUPY THE PREMISES AND THAT IT IS A VIOLATION OF THE CITY CODE FOR ANY PERSON NOT LISTED ON THE OCCUPANCY PERMIT TO OCCUPY OR TO BE ALLOWED TO OCCUPY THE PREMISES. PLEASE PROVIDE YOUR PHOTO IDENTIFICATION SO THAT A COPY MAY BE MADE TO ATTACH TO THIS APPLICATION FORM.
78. Electronic Signature:
79. Date:
Leave This Blank:


81. 1. Receive an email copy of this form.
82. Email address

    This field is not part of the form submission.

83. Submit

* indicates a required field