DYE TEST APPLICATION - Washington

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CITY OF Washington CITY CLERK S OFFICE 55 W. MAIDEN STREET Washington , PA 15301 PHONE: (724) 223-4200 FAX: (724) 223-4229 DYE TEST APPLICATION 1. Please provide all information requested. 2. The fee of $ must accompany this APPLICATION . Make check payable to the City of Washington . 3. Should the property fail the first inspection, each additional inspection shall be billed at $ 4. Upon passing the inspection, a Document of Certification shall be issued by the City Clerk. The Certification will be valid for one (1) year from the date of issuance. Please Provide the Following Information About the Property to be Sold Property Address: ________________________________________ ______________________ Property Owner(s)/Seller: ________________________________________ ________________ Owner s Address (if different than property address): ___________________________________ ________________________________________ ______________________________________ Owner s Telephone Number: ________________________________________ _____________ Parcel No.

CITY OF WASHINGTON CITY CLERK’S OFFICE 55 W. MAIDEN STREET WASHINGTON, PA 15301 PHONE: (724) 223-4200 FAX: (724) 223-4229 www.washingtonpa.us DYE TEST APPLICATION 1. Please provide all information requested. 2. The fee of $225.00 must accompany this application.

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