Safe Housing Tips
Available Housing Questionnnaire

 

Date: Filled out by:
Contact:  Phone:
Address of Unit
For Sale  For Rent  Price $  When Available:__/__/__

 

IF FOR RENT

By Owner  By Property Manager  Name
Month-To-Month  Lease  How Long

Pets Allowed? Yes  No  What Kind?

TYPE OF UNIT

Room (Check type of Unit Below)

House  2,3,4-Plex  Townhouse  Apartment in complex

Condo  Trailer  In-Law/Guest Unit  Other

DESCRIPTION OF UNIT

Age of house  Size (Sq. Ft)  Parking
# Bedrooms   # Bathrooms
Construction: Frame  Adobe  Other
If Trailer: Length Model

TYPE OF LOCATION

General Location:

Is it Near: Freeway  Busy Street  Industry  Farming
High Power Lines  Construction  Other:

UTILITIES

Heating  Source:
Electric		 Natural Gas  Propane  Solar  Wood Stove
Heat Type:
Floor Radiant		  Water Baseboard  Electric Baseboard  Forced Air  Other
Hot Water heater:
Electric		  Gas  Propane  Solar
Equipment Room Location:

Stove/Range:  Electric  Gas  Propane   Solar  Other

FLOORS
Carpet How old?  Tile: Type  Brick  Concrete  Wood  Linoleum

Where?

 

ROOF
Tar  Metal  Shingle   Other  Age

HISTORY

Was unit remodeled in last 2 years?  Yes  No  Don't know
When?  What was done?

Have pesticides been used in last 2 years?  Yes  No  Don't know

Has there been:
SmokingWhen?		 Incense
When?		  Aromatherapy
When?		  Moth ball use
When?

Have there been Pets in unit?  Yes No  Don't know

Is Unit presently occupied? Yes  No

Can we contact previous occupants? Yes
Name _______________________Phone		  No

MOBILITY ACCESSIBILITY

Is unit Wheelchair Accessible? Yes  No

NEIGHBORS

Description/ Characteristics/Life Style:

 

MISCELLANEOUS

Special Features or circumstances:

Comments