***DO NOT MAIL THIS APPLICATION***
Job Number: (for office use only)
(PERMIT TYPE PREFIXYEARNUMBER)
Page 1 of 2
P_001_F (Rev 12.2021)
Location’ field. If applicable, list PR #.
Check box if this application is part of a project and provide project number:
1
Application for Construction Permit
Use this application to obtain permits for a residential or commercial construction proposal.
Mechanical / Fuel Gas, Electrical, Plumbing, and Fire Suppression trade details are found on page 2.
Address
Identify the location of work for the
permit(s).
If the activity will take place in a specific
building, tenant space, floor level, or
suite, note that detail in the ‘Specific
Parcel Address
Specific Location
Applicant
Identify how you are associated
with the property.
Licensed professionals include design
professionals, attorneys, and
I am the:
Name
Property Owner
Tenant
Equitable Owner
Company
Licensed Professional or Tradesperson
expediters. A tradesperson must have
an active Philadelphia license for their
trade or hold a PA Home Improvement
Contractor Registration.
Address
Email
Property Owner
Identify the deeded property
owner.
If the property owner is a ‘company’,
a separate supplemental ownership
information form will be required.
If there was a recent change of
ownership, documentation such as a
deed or settlement sheet will be
required.
The property owner is a/an: Individual Company (if selected, complete a separate Supplemental Ownership Information Form)
Address
Email
Design Professional in
Responsible Charge
Identify the PA- licensed design
professional who is legally
Name Firm
responsible.
PA License #
Phila. Commercial Activity License #
Project Scope
Use this section to provide project
details; all fields are mandatory.
(a) Choose the proposed occupancy
of the entire building. If not one- or
two-family, provide a description of
group(s) per code.
(b) Identify if the project will be new
construction, an addition, or
interior/exterior alterations.
(c) List the site area that will be
disturbed by construction, if any.
Enter ‘zero’ if no disturbance.
Email
(a)
Occupancy
Single-Family Two-Family Other, please describe:
(b)
Scope of Work
New Construction Addition and/or Alteration Shell (No Fit Out)Option for Commercial Permits Only
(c)
Earth Disturbance
Area of Earth Disturbance (Sq. Ft.)
(d)
Building Floor Areas
(d) Note the new floor area created,
including basements, cellars, and
occupiable roofs. Where existing
areas will be altered, list those areas
separately.
(e) State the number of new or
affected stories.
(f) Provide a detailed description of
the work proposed.
(g) Select all conditions that apply to
this project (if any).
*Provide the associated Streets
Review number if “Project Impacts
Streets/Right-of-Way” is selected.
New Floor Area (Sq. Ft.) Existing Altered Area (Sq. Ft.)
(e)
Number of Stories
(f)
Description of Work
(g)
Project Conditions
New High Rise Green Roof Included Initial Fit Out of Newly Constructed Space
Modular Construction Façade Work Project Impacts Streets/Right-of-Way*
*Provide the associated Streets Review number for this project, if applicable:
SR - 2 0 --
Check box if new owner is being listed
5
Phone
Phone
Phone
PR- 2 0
-
4
3
2
***DO NOT MAIL THIS APPLICATION***
Job Number: (for office use only)
(PERMIT TYPE PREFIXYEARNUMBER)
Page 2 of 2
P_001_F (Rev 12.2021)
(g) Total Improvement Cost: $________________________
(The total improvement cost must also include the cost of all electrical, plumbing, mechanical, fire suppression systems work, and interior finishes)
(g) Provide the total improvement
c
ost for residential (including multi-
fami
ly) alterations and additions.
Phone
Phone
Phone
Project Details &
Contractor Information
(a) Select all disciplines of work
(a)
Check all that apply:
Building Mechanical & Fuel Gas Electrical Plumbing Fire Suppression
for which permits are being
requested. If ‘Building’ is not
requested, provide the number
Note: Trades listed below are mandatory for all residential
new construction jobs.
RP or CP- 2 0 -
of the associated permit that
was previously issued (where
applicable). If a Zoning Permit
was issued for this work, provide
the related permit number.
(b)
Identify the general
contractor and estimated cost of
building construction.
(c)
Identify the mechanical
contractor, estimated cost of
mechanical work, equipment
Provide the associated Zoning Permit number for this construction, if applicable:
ZP- 2 0 -
(b)
General Building Construction Contractor Information
Name Cost of Building Work $
License Number
(c)
Mechanical/Fuel Gas Work & Contractor Information
type, and quantity as:
Number of registers/
diffusers (separate
new/relocated)
Number of appliances
Name
License Number
Cost of Mechanical Work $
Cost of Fuel Gas Work $
Number of Type I /
Type II kitchen hoods
Where fuel gas work is included,
Equipment Types:
Registers / Diffusers Appliances Hoods
note the estimated cost of fuel
gas work.
Equipment Detail & Quantities
(d)
Identify the licensed
electrical contractor, estimated
(d)
Electrical Work & Contractor Information
New Installation Alteration *Rough-In
cost of electrical work, and a
registered third-party electrical
inspection agency.
(e)
Identify the registered master
plumber, estimated cost of
Name
License Number
Cost of Electrical Work $
plumbing work, number of
fixtures, and check location of
Third-Party Inspection Agency Name
work as:
Interior
Exterior Drainage and/or
(e)
Plumbing Work & Contractor Information
N
ew Installation
Alte
ration
*
Rough-In
Water Distribution
(f)
Identify the licensed fire
suppression contractor,
estimated cost of fire
suppression work, and number
of devices:
Sprinkler Heads
(separate new/
relocated quantities)
Name
License Number
Check one:
Number of Fixtures
Cost of Plumbing Work $
Interior Work Exterior Building Drainage
Exterior Water Distribution; line size (in.)
Standpipes
Fire Pumps
(f) Fire Suppression Work & Contractor Information
New Installation Alteration *Rough-In
Stand-alone Backflow
Prevention Devices
Kitchen Extinguishing
Systems
Hydrants
Name
License Number
Cost of Fire Supp. Work $
*ROUGH-IN NOTICE: If you are
seeking a rough-in permit, an
application for plan review must
be submitted already.
Declaration & Signature
Sprinkler Heads: Standpipes: Fire Pumps:
Commercial Kitchen Systems: Backflow Devices: Hydrants:
All provisions of the Building Code and other City ordinances will be complied with, whether specified herein or not. Plans approved by the Department form a
part of this application. I hereby certify that the statements contained herein are true and correct to the best of my knowledge and belief. I further certify that I am
authorized by the owner to make the foregoing application, and that, before I accept my permit for which this application is made, the owner shall be made aware
of all conditions of the permit. I understand that if I knowingly make any false statements herein, I am subject to such penalties as may be prescribed by law or
ordinance, inclusive of the penalties contained in 18 Pa. C.S. § 4904.
Applicant Signature: Date: / / _
Phone
Phone
6