They are usually granted fairly easily but need to be renewed, that's how they manage you.

You should definitely reach out to @Frank Avallone II and go over the requirement.

I'm in the process of reaching out to the city admin who handles this area to see if I could either be (a) reimbursed or (b) have registration waived for the next handful of years.

Should I reach out to the surrounding home builders to see if they are interested in buying?

Feel free to reach out if you have any specific questions. 

I have used PropStream/Repropfinder's skip tracing service (60% success rate) and I reach home owners and buyers on the phone with regularity.

If a phone/remote chat would be easier, just let me know.Thanks for reaching out!

If I were you, I would hustle like crazy to reach out to owners of existing multi-family properties that fit your criteria and see if they would be interested/willing in selling their property to you for the "right price." 

You may also want to consider reaching out directly to your local hospitals.

Thanks from San Diego, Josh Hey Josh, I just sent you a message about Cincinnati Hi Sam, Thanks for reaching out.