UCC-4 APPLICATION FOR DEMOLITION PERMIT - Codes Assessment Professionals

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APPLICATION FOR UCC DEMOLITION PERMIT

Today's Date(Required)

Check that applies

EXPEDITE REVIEW. ADDITIONAL FEE SUBMITTED.

ACT 24 EXEMPTION

Site Information

Political Subdivision and County names are required.

Facility Name (name of company, mall, institution, university, etc.):

Building and/or Tenant Name

Street Number and Name(Required)

City(Required)

State(Required)

Zip Code(Required)

Political Subdivision(Required)

County(Required)

Contact Name

Phone

File Number (if approved for occupancy by L & I)

With or without foundation

With Foundation

Without Foundation

Is it in a flood plain

Yes

Is it in a flood way

Yes

Will there be a rebuild after demolition?

Yes

If Yes Please Explain

Site Plan Requirements

Location of all buildings or structures to be demolished, distances to property lines and distances to sidewalks, pavement and curbs where they abut property lines.
Location of any existing buildings or structures that will remain on the site.
Area to be filled to existing grade and seeded or to be fenced and otherwise protected in anticipation of new construction.
If applicable, location, dimensions and construction details for pedestrian protections required in section 3306 of the International Building Code.

Owner and Applicant Information

Applicant Name(Required)

Street Address(Required)

City(Required)

State(Required)

Zip Code(Required)

Phone(Required)

Fax

Email(Required)

Property Owner

Same as the applicant

Owner Name(Required)

Street Address(Required)

City(Required)

PA(Required)

Zip Code(Required)

Phone(Required)

Owner Statement
I/we, signed name(s)] certify that I/we own the property described above for which this application is made for a UCC demolition permit and that the applicant has my/our approval to demolish this property or act as our agent in the demolition of this property.

Name

Date

File

Drop files here or

Max. file size: 1 GB, Max. files: 10.

Invoice & Payment

Where should we send the invoice?(Required)

Enter the name and the mailing address or email address the invoice should go to. Payment can be made by check (mailed or dropped off at our office) or by card.

UCC 4 Form

APPLICATION FOR UCC DEMOLITION PERMIT

Site Information

Site Plan Requirements

Owner and Applicant Information

Owner Statement I/we, signed name(s)] certify that I/we own the property described above for which this application is made for a UCC demolition permit and that the applicant has my/our approval to demolish this property or act as our agent in the demolition of this property.

Invoice & Payment

Owner Statement
I/we, signed name(s)] certify that I/we own the property described above for which this application is made for a UCC demolition permit and that the applicant has my/our approval to demolish this property or act as our agent in the demolition of this property.