// PAGE DISABLED Vacant Building Ordinance : Forms
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ENGINEERING AND CONSTRUCTION MANAGEMENT DEPARTMENT
BUILDING PERMITS AND INSPECTIONS DIVISION



Current Vacant Building Certificate #

I am requesting cancellation, transfer or exemption (Circle One) of the vacant building certificate, as identified in 18.40.030(I, J, K), for the following reason(s):



Changed Ownership Became Occupied Was demolished






Additional information submitted with this application to support this request:
Sale or conveyance document: (Yes/No)             Demolition Record Issued: (Yes/No)


Other Documents or Comments:

Transfer to:


Name:


Address:


Telephone:


Emergency Response Information for Contact Individual (must be within one hour response time,
available 24-hours per day, seven days per week as required by 18.40.120(A)).

Emergency Contact Name:


Emergency Contact Address:


Emergency Contact Telephone:

I am requesting an exemption from the vacant building certification process, as identified in 18.40.040, for the following reason(s):

The vacant building was damaged by fire or extreme weather on
and will be repaired within ninety (90) days.

Detailed statement of the extent of damages:
It is my intent to repair and reoccupy the building in an expedient manner by
It is my intent to demolish the structure on the property by



PIDN: (Central Appraisal Tax Identification Number)

Location:

Legal Description:
Subdivision/Survey: Block Lot



Building Address:
Street Number Street Name



Space or Suite Zip Code

AFFIDAVIT:
I hereby certify that I am the current owner of the property and have read and examined this application and know that same to be true and correct. I also certify that I have read and understand the requirements concerning vacant buildings in Title 18.40 of the El Paso Municipal Code.