Form Ucc-3 - 2007 Application For Building Permit Page 2
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1
2
3File #:
________________
Permit #:
________________
Date:
________________
S4
Project Data
Lot Number:
____________
Block Number:
____________
Does municipality have a zoning ordinance?
Yes
No
If “Yes,” has permit been acquired?
Yes
No
If “Yes,” list date acquired: ________________
Minimum setbacks required by municipal zoning ordinance (in feet):
Front: _____
Rear: _____
Right Side: _____
Left Side: _____
Sq. ft. of conditioned space
__________
Sq. ft. of unconditioned space
__________
Number of stories above grade
__________
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.)
__________
# of multi-family dwelling units
__________
# of accessible dwelling units
__________
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 is “legally occupied”, indicate permits held:
Fire and Panic Occupancy Permit
File Number: _________________
Municipal Occupancy Permit
Permit Number: _________________
Municipality Name ____________________________________
L&I UCC Certificate of Occupancy
File number: _________________
If “legally occupied,” you must select which code requirements the building will comply with
(choose only one):
International Existing Building Code
Chap. 34, International Building Code
Which triennial codes must this work comply with?
2003
2006
Electricity Provider:
____________________________________
Gas Provider:
____________________________________
Design
Professional
In Responsible
_________________________________
Name:
Charge
_________________________________
Address:
SEAL
_________________________________
Seal must be in
_________________________________
PA License #:
space to right of
E-Mail:
_________________________________
name & address.
_________________________________
Phone:
Fax:
_________________________________
UCC-3 REV 1-07 (Page 2)
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