Construction Permit Application Short Form
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1
2Date Received: ______________
Permit Number: _________________
Code Inspections, Inc.
Construction Permit Application – Short Form
For residential projects only – read entire application (both sides) before completing
County ______________________________ Municipality ___________________________________
Application Date ____________________ Approval Date _________________________________
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Location of Proposed Work:
Site Address____________________________________________________________________________
Tax Parcel # _________________________
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Type of Work or Improvement:
Demolition
Deck
Deck/Porch w/roof
Pool
Foundation only
Electrical
Plumbing
Mechanical
Repair
Other (describe)
Describe Proposed Work:
_______________________________________________________________________________________
_________________________________________________________________________________________
Estimated Cost of Construction/Demolition $___________________________________________
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Owner ___________________________________ Phone # _____________________________________
Mailing Address ________________________________________________________________________
Applicant ________________________________ Phone # ____________________________________
(If other than owner)
Contractor _______________________________ Phone # ____________________________________
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Flood Plain:
Is the site located within an identified flood zone?
Yes
No
Will any portion of the flood zone be developed?
Yes
No
Owner/Agent shall verify that any proposed construction and/or development activity complies with the requirements of the
National Flood Insurance Program and the Pennsylvania Flood Plain Management Act )Act 166-1978), specifically section 60.3.
Lowest floor level: ______________
DEP Approval Provided _______________________________
Historic District:
Is the site located within a historic district?
Yes
No
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Documents to be provided:
Zoning/Twp. Approval
Drawings (3 copies)
Manufacturers Specifications (as required)
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Parent category: Business