Ucc Appeals Board Application
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1
2UCC A
B
A
PPEALS
OARD
PPLICATION
PROPERTY INFORMATION
Property Address: _______________________________________________________
Zoning District: ________ Ward: _______
Owners Name:________________________________________________________
Parcel ID: ________ - _____ - ________
Address: ______________________________________________________________
Phone: (
) _______________
City: ______________________________State:______ Zip Code: _____________
Fax:
(
) _______________
APPLICANT INFORMATION
Name: ____________________________________________________________________________________________________
Address: ______________________________________________________________
Phone: (
) _______________
City: ______________________________ State:______ Zip Code: _____________
Fax:
(
) _______________
________________________________
____________________________________________________
Date of Application
Signature
VARIANCE / INTERPRETATION INFORMATION
The owner/applicant requests that a determination be made by the Homestead Borough UCC Appeals Board on the following appeal,
which was denied by the Homestead Borough Building Code Official on ________________ , 20 _____.
□
□
the Homestead Borough Code of Ordinances, Chapter 124 – Uniform Construction
An interpretation
A variance to
Code , Section ________, subsection ________ , Section ________,subsection _______;, Section ________, subsection________
for the following reason(s):
□
It is an appeal for the interpretation of the relevant code.
□
It is a request for a variance relating to (state the variance briefly):
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
The description of the property in this application is as follows:
Present improvement on lot:: _____________________________________________________
Lot size: __________ square feet
Current or former use: ________________________________________________________________________________________
Proposed use: ______________________________________________________________________________________________
I / we believe that the UCC Appeals Board should approve this request because: (Include the grounds for the appeal or reasons with
respect to law and fact for granting the appeal or variance, and/or if hardship is claimed, state the specific hardship)
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
□
□
Has any previous application or appeal been filed in connection with these premises?
No
Yes- please list dates and results:
__________________________________________________________________________________________________________
□
□
□
□
What is the applicant’s interest in the premises affected?
Owner
Agent
Lessee
Other - _______________________
STATEMENT OF TRUTH
COMMONWEALTH OF PENNSYLVANIA COUNTY OF ALLEGHENY
Deponent, being duly sworn, says they are the:
□
Owner of record of the property for which this application is made, and that all the statements and data furnished with this
application are true and correct.
□
Authorized agent for the owner of record of the property for which this application is made and as such has express authority to
bind such owner to all terms and conditions of any building, fire or occupancy permit issued pursuant to this application, and that all
statements and data furnished with this application are true and correct.
Sworn to and subscribed before me this ______ day of _______________________ 20 ______.
_________________________________
_________________________________
__________________________________
Notary Public
Applicant (signature)
Applicant (printed)
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