IDENTIFICATION
APPLICANT STATEMENT
Please state the requirements of the subcode from which a variation is sought. (Use separate application forms for each
variation request):
DETERMINATION
This appplication is to be reviewed within 20 business days.
After reviewing the facts, we [ ] DENY [ ] GRANT the above variation request, in accordance with N.J.A.C. 5:23-2.9 through
2.13, for the following reasons:
How would compliance with said provisions result in practical difficulties? Explain the nature and extent of these difficul-
ties:
U.C.C. F160 (rev. 5/2003)
APPLICATION
FOR A
VARIATION
Block Lot
Contractor
License #
Address
Tele.
Federal Emp. #
Work Site Location
Date
Building Subcode Official
Plumbing Subcode Official
Elevator Subcode Official
Electrical Subcode Official
Fire Subcode Official
Construction Official
Tele.
Address
FEE $
Owner in Fee
(Determined by Enforcing Agency)
Please state an alternative to the subcode requirement that will still protect the health, safety and welfare of the occupants:
Date Received:
Control #:
Date Issued:
Permit #:
Date Revised:
Date Permit Issued:
Qualification Code
*
DATE
SIGNED
APPLICANT
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