Building/Zoning Permit Application Received:
Lancaster Township • 1240 Maple Avenue
Lancaster, PA 17603 • (717) 291-1213 • Fax (717) 291-6818
www.twp.lancaster.pa.us

_ Dwelling _Commercial _Addition _Finished Basement _Renovation _Deck _Garage _Driveway

_ Shed _Demolition _Patio _Electrical _HVAC _Plumbing _Pool: __ Above Ground __ In Ground
_ Fence _Grading _Other _____________________________________________

Project Address: ________________________________________________________________

Project Description: _____________________________________________________________

_____________________________________________________________________________

Applicant Name: ________________________________________ Phone: __________________

Mailing Address: _______________________________________ Cell #: ___________________
Fax #: ___________________
Subdivision: ___________________________________________ Lot #: ___________________
Property Owner’s Name (if different from above) ___________________________________________________
Owner’s Phone: ________________________________________________________________
Property Owner’s Address:                                                                                                                 (City)                                                (State)                         (Zip)                       
Project Cost: ____________________________Total Square Footage: ______________________
*List renovation costs separately from addition costs

Project start date:_____________________ Project completion date: ______________________

Contractor: ________________________________ Contractor Phone #s: ___________________
Contractor Address: ___________________________________

Contractor Fax: _______________

Proof of contractor’s workers’compensation insurance?  Yes*   No

(If no, please complete exemption form)   *Your insurance company must provide a Certificate of Insurance listing Lancaster Township as the certificate holder.

__ I am the owner of this property and I am assuming all insurance responsibilities for this permit.

_______________________________________________    _____________________________
(Signature)                                                                                 (Date)

Two complete sets of detailed site plans (must show property lines), and two complete sets of detailed building construction plans must be submitted for review and approval; water, sewer, and highway permits must also be submitted if required. If there are subcontractors, contractor listing supplement sheet must be filled out.

Office Use Only

Parcel # _______________________________ Permit # ____________________________

Lancaster Township Building Permit Application

Contractor Listing Supplement Permit #___________

General Contractor:

Business Name _________________________________________________________
Contact _________________________________ Phone ________________________
Address _______________________________________________________________
City ______________________________ State _____________ Zip ______________
Fax _________________________ Cell ________________ Pager ________________

Electrical Contractor:

Business Name _________________________________________________________
Contact _________________________________ Phone ________________________
Address _______________________________________________________________
City ______________________________ State _____________ Zip ______________
Fax _________________________ Cell ________________ Pager ________________

Plumbing Contractor:

Business Name _________________________________________________________
Contact _________________________________ Phone ________________________
Address _______________________________________________________________
City ______________________________ State _____________ Zip ______________
Fax _________________________ Cell ________________ Pager ________________

HVAC Contractor:

Business Name _________________________________________________________
Contact _________________________________ Phone ________________________
Address _______________________________________________________________
City ______________________________ State _____________ Zip ______________
Fax _________________________ Cell ________________ Pager ________________

Electrical Inspection Agency:

Business Name _________________________________________________________
Contact _________________________________ Phone ________________________
Address _______________________________________________________________
City ______________________________ State _____________ Zip ______________
Fax _________________________ Cell ________________ Pager ________________

(Please list additional contractors below or on reverse side)