Application for Building Permit / use Certificate

PROPERTY INFORMATION

Tax Map *

Parcel No. *

Site Address *

Address Line 1

Address Line 2

City

State

Zip Code

Zone *

OWNER'S INFORMATION

Name *

First

Last

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

BUILDING PERMIT APPLICATION

Description of Work (provide details on plan along with existing structures on lot). *

Description of Work (provide details on plan along with existing structures on lot).

Upload pictures/sketches

Click or drag files to this area to upload. You can upload up to 5 files.

Upload any relevant pictures, sketches. etc. that help describe or illustrate above information provided.

Estimated cost of construction *

Estimated start date *

Estimated completion date *

CERTIFICATION

Signature and Date *

I herby certify that I am the owner of record of the named property, or that the proposed work is authorized by the owner of record and that I have been authorized by the owner to make this application as his authorized agent and I understand and assume responsibility for the establishment of official property lines for required setbacks prior to the start of construction, and agree to conform to all applicable laws of this jurisdiction. I further certify that this information is true and correct to the best of my knowledge.

Signer's Address *

Address Line 1

Address Line 2

City

State

Zip Code

Signer's Phone *

CONTRACTOR INFORMATION

Name of Contractor *

Phone *

Chief Executive Officer *

Phone *

Person in charge of work *

Phone *

Contractor Address *

Address Line 1

Address Line 2

City

State

Zip Code

PA Contractor License No. *

Proof of "workman's compensation" insurance *

Click or drag a file to this area to upload.

SUBCONTRACTOR INFORMATION

Please list subcontractors for major trades

Contractor

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Contractor

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Contractor

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Contractor

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Contractor

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Additional Contractors over 5 if needed. Please include name, address, and phone number of each.

PROPERTY INFORMATION

OWNER'S INFORMATION

BUILDING PERMIT APPLICATION

CERTIFICATION

CONTRACTOR INFORMATION

SUBCONTRACTOR INFORMATION

APPLICANT OR AUTHORIZED AGENT IS RESPONSIBLE FOR CONTACTING INSPECTOR FOR REQUIRED INSPECTIONS