LEHIGH ENGINEERING, LLC UCC PERMIT APPLICATION
Ph. 570.628.2300
Building Permit __________________________________ Fire Protection Permit ________________________________
Municipality __________________________________________________ County _____________________________________
Construction Site Location ________________________________________________________ Date Received _____________
Owner ____________________________________________ Applicant/Tenant _____________________________________
Address ___________________________________________ Address ____________________________________________
State ______ Zip ___________ Phone #_________________ State _____ Zip _________ Phone #___________________
Describe Proposed Work in Detail: ____________________________________________________________________________
________________________________________________________________________________________________________
FIRE PROTECTION PERMIT
Contractor _________________________________________or/ Sub-Contractor .
(if owner put same as above)
Address _________________________ _________________ Sprinkler System: _____________Sprinkler Heads ____
City ____________________ State ______ Zip ____________ ________ _____________________________________
Phone ___________________ Cell______________________ Alarm System: _________________ ___________________
Federal Employee # _________________________________ ________ _____________________________________
[Certification of Insurance for Workers Compensation needed or sig n exemption form]
State Classification: ( Official Use )
Commercial Cooking Equip.: ________________________ ________
New Residential _____ Other Residential _____
Other: ______________________________________________
New Commercial _____ Other Commercial _____
*Estimate Total Costs this Work ___________________________
CODE OFFICIAL USE ONLY
[ ] Plans Approved
UCC Building Fee: _________ _______ + Fire Fee: [ ] Plans Approved with Comments
Plan Review Fee: ______ _
Admin Fee: ___________________ Code Official: _____ ____ _______ ____
State Fee: _________________ State Cert. #: _____ ____
Sub-Total : _____________________________Total UCC Fees _____________ Date: _______________ _____
BUILDING PERMIT
Contractor _________________________________________ PA CID #
(if owner put same as above)
Address ____________________________________________ *Total Estimated Cost $ __________________________
City ____________________ State ______ Zip ____________ Total SQ FT __________ # of Stories _______ Height ______
Phone ___________________ Cell__________________ ____ Description of Work: _________________________________
Federal Employee # __________________________________ ________ __________________________ _________
[Certification of Insurance for Workers Compensation needed or sig n exemption form] Addition ( ) Deck ( ) Roof ( ) Pool ( )
Additional Information: __________________________________________________________________________________
( Official Use ) State Classification: Use Group _______ Construction Class _______
New Residential _____ Other Residential _____ New Commercial _____ Other Commercial ____
__
I hereby acknowledge that I have read this application and state the above is correct to comply with all
Municipal ordinances and state laws regarding construction.
Signature: _____________________________ _____________
Owner ( ) Contractor ( ) Owner Representative ( )