Form Ucc-3 - Application For Ucc Building Permit Page 2
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1
2
3Number of stories above grade
Project Data
Does it have a basement?
Yes
No
Total floor area (sq. ft.)
Floor area new construction (sq. ft.)
Floor area of addition (sq. ft.)
Floor area renovated (sq. ft.)
Estimated cost of construction
$
(Required -- even if project is state-owned and exempt from permit fees.)
Type(s) of construction per Chapter 6 of the International Building Code (check all that apply):
IA
IB
IIA
IIB
IIIA
IIIB
IV
VA
VB
Fire suppression:
Full
Partial
None
If application applies to an existing building that has been certified, indicate permits held:
Fire and Panic Occupancy Permit
File Number:
L&I UCC Certificate of Occupancy
File number:
Triennial ICC code version used for Building code compliance:
Building Code
2006
2009
Data
If Alterations to existing certified building: (select applicable document used)
IBC Chapter 34
International Existing Building Code
Triennial ICC code version for Accessibility code compliance/IBC Chapter 11 (select one)
Accessibility
2006
2009
2012 (design contracts between Jan. 1, 2013 and
Code Date
March 31, 2016)
2015 (design contracts starting April 16, 2016
If Alterations: (select one, either document may be used for projects under design
contract prior to Jan. 1, 2013)
IBC Chapter 34
(2012 must be used to support accessible alterations under design between Jan. 1, 2013
and March 31, 2016)
International Existing Building Code (IEBC)
(2015 must be used to support accessible alterations under design contract starting April
16, 2016)
Name
Design
Address
Professional
In Responsible
PA License #
Charge
SEAL
Email
Seal must be in
Phone
(
)
space to right of
name & address.
Fax
(
)
Owner Name
Owner
Street Address
Information
City
State
Zip Code
Phone (
)
UCC-3 REV 04-16 (Page 2)
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