APPLICATION FOR BUILDING PERMIT

CONTRACTOR INFORMATION:
Business Name*
Office Phone Number*
Please enter a valid phone number.
Business Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Name*

First NameLast Name
Direct/Cell Number*
Please enter a valid phone number.
Email*
example@example.com
PA Home Improvement Contractor (HIC) Number*
Expiration Date

MonthDayYear
Date
ARCHITECT/ENGINEER INFORMATION:
Business Name*
Office Phone*
Please enter a valid phone number.
Business Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Name*

First NameLast Name
Direct/Cell Number*
Please enter a valid phone number.
Email*
example@example.com

CERTIFICATION:
I certify that I am the owner of record, or that I have been authorized by the owner of record to submit this application and that the work described has been authorized by the owner of record. 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 local, state and federal laws governing the execution of this project. I certify that the Code Official or his representative shall have the authority to enter the areas in which this work is being performed at any reasonable hour to enforce the provisions of the codes governing this project. I further certify that this information is true and correct to the best of my knowledge and belief.
Applicant Name*

First NameLast Name
Applicant Email*
example@example.com
Applicant Phone Number*
Please enter a valid phone number.
Applicant Signature*

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Date*

MonthDayYear
Date
REQUIRED DOCUMENTS:
1. New Construction – 2 sets of construction plans
2. Pre-manufactured construction – manufacturer specs for structure
3. Interior Alterations – Floor plan of existing condition and proposed changes with complete description of work
4. Swimming Pool – manufacturer’s installation specs for pool and pump
5. Roof repair/replacement – full narrative of work or copy of contract. Any structural repair must submit plan
6. Generator – manufacturer’s installation specs, electrical line drawing, image/drawing showing proposed location
7. Solar Panels – 2 sets of construction plans, structural analysis of roof sealed by architect/engineer licensed in PA
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