SAYRE CODE ENFORCEMENT AGENCY BUILDING PERMIT. APPLICATION MEMBER ICG NIERNAIHONAL CODEC COUNCIL TNssertlions siobccipleted An4.p pail Dale tecesed Kecevalky HOV W. Packer Ave Sayre, PA 18840 570-88-888-410FAX570-88-6598 lylheCoieorce MEMUER PROJECTED START DATE: PROPERTY OWNER'S NAME: STREET ADDRESS FORI PERMIT: Single family Residential or Commercial OWNERSTELEPIONE (home#): SEWER: TOTAL COST OR VALUE OF PROJECTS Multi-family Residential Miut-amiyRuidemta, #of Units Commercial/with residentinl units #ofUnits IrMulti-family with more than 2 units, property is considered Commercial (work#): (well) (cell#) (public) (scptic). (#ofEDU'S) WATER: (public) HEATING SYSTEM IS: (hotair) (electric) (hot water) CONTRACTOR INFORMATION- - List all contractor's doing work- Ifyou arc using more than one contractor, please list the work to be performed by each contractor: *Ifproperty owneri is doing their own work, see exemption. ROJECTDESCHIPTON: (please explain in detail) Remember-if: you are digging calll PA-ONE CALL (811). IFDRIVEWAY - PENN-DOT APPROVAL: BOROUGH APPROVAL: PROJECTSKETCH NOTE: Theowner must verily allp pruperty lines. Rtist thes responsibillty: ofihe owher: and thes cuairaclerlo khuw anda adhere to all Felevant codes and urdinances. Questions should bes directedto the Code Ollceat 571-158-4410. INCLUDE ALLE BUILDINGS. SET BACKS. MEASUREMENTS. ETC. EXEMPTION FROM WORKER's COMPENSATIONI INEURANCE:lfpropany. ovner slates ahatl they are doing thcire own work, by signing this THIS PORTION TO BE COMPLETED! BY CODE ENFORCEMENT OFFICE: Sidewalk Check- Sitel Inspection Pass Fail application thie property owner: allirms that they will not hire ny employce (vontractur) to werk on the projec, APPLICANT'S: SIGNATURE, Date received: Permit Number: Date Approved: Denied: Reason for denial: DATE hairatiegesex Project cost: Permit Feet Date of final inspection: Initials ofi inspector: CODE OFFICERSSIGNATURE FOR APPROVAL: DONTFORGETTOCALLBI1ORII-S00-242-1776) PAONE CALL BEFORE YOUDIG.