***DO NOT MAIL THIS APPLICATION***
Job Number: (for office use only)
(PERMIT TYPE PREFIX – YEAR – NUMBER)
(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.
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: / / _
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