Application Form For Mechanical/electrical/plumbing Permits printable pdf download

City of Lancaster, PA.

120 North Duke Street P.O. Box 1599 Lancaster, PA 17608

8:30 AM - 5:00 PM Permits and scheduling - 717-291-4724

Application for Mechanical/Electrical/Plumbing Permits

Separate permit is required for each waste water lateral connection, commercial and residential.

APPLICANT/CONTACT PERSON: (Print clearly) ________________________________________________

COMPANY COMPLETING APPLICATON: ______________________________________________________

Address: ____________________________________________________________________________________

Telephone Numbers:

Home/Office # _________________

Cell # ____________

Fax: _________________

Email Address: _______________________________________________________________________________

PROPERTY OWNER: _____________________________________________________

Same as above

Address: ____________________________________________________________________________________

Telephone Numbers:

Home/Office # _________________

Cell # ____________

Fax: _________________

Project Location/Street Address: _______________________________________________________________

(Must include Apartment/unit or Suite Number if applicable)

Residential

Commercial

Bldg Code Change of Use

Adding or expanding # of rental units

Contractors must provide a Certificate of Insurance listing the City of Lancaster as the certificate holder.

MUST PROVIDE COPY OF CONTRACT/PROPOSAL OR NARRATIVE WITH APPLICATION

Mechanical Work: Provide a scope of work (detailed description of work) to be performed: $ _______________

____________________________________________________________________________________________

Contractor Information: Name: __________________________________________Cell #____________________

Home Improvement Contractor’s License #: ________________________________________________________

Manufacturers’ installation instructions must be available at the job site at time of inspection for each appliance.

Electrical Work: Provide a scope of work (detailed list of work to be performed): $ ________________________

____________________________________________________________________________________________

Contractor Information: Name: __________________________________________Cell #____________________

Home Improvement Contractor’s License #: ________________________________________________________

PP&L Work Number: __________________________________________________________________________

Plumbing Work: Provide a detailed scope of work to be performed $ ____________________ including a list of

fixtures to be reset or replaced: ___________________________________________________________________

____________________________________________________________________________________________

Contractor Information: Name: __________________________________________Cell #____________________

Home Improvement Contractor’s License #: ________________________________________________________

Lancaster City Master Plumbers Name: _________________________________________________________

Sewer Lateral Connection:

YES

Sewer lateral repairs:

YES

*Restrictions on specific materials used in plumbing system apply.

Total number of fixtures to be reset or installed: ________________

OFFICE USE ONLY

Code Compliance Office Review/Approval: _______________________________ Date: _______________

Permit # ________________

Permit Fee: $_____________ State Fee: $ 4.00

Total Fee: $ ______________

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8/4/14

Application Form For Mechanical/electrical/plumbing Permits

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