COPLAY BOROUGH

98 South 4th Street

Coplay, PA 18037

Office: 610-262-6088   Fax: 610-262-4591

 

ZONING PERMIT APPLICATION FORM

This form must be completed and neatly printed or typed

 

Date Received: ______________                                            Coplay Permit # ______________

 

                                               

                                                                                                                                               

 

 

Owners Name _____________________________________________________________

 

Address of Property __________________________________________________________

 

Phone # ___________________________       Alternate # ___________________________

 

 

 

 

Contractor Info ____________________________________________________________

 

Address ___________________________________________________________________

 

Phone # ___________________________       Alternate # ___________________________

 

Pennsylvania Home Improvement Contractor # (PAOAGHIC #) _______________________

 

 

                                 □ Shed                      □ Other                       □ Fence

 

 

Information: ________________________________________________________________

______________________________________________________________________________________________________________________________________________________________________________________________________________________________

Include type of fence; examples: chain link, stockade, etc. and the length and height of each section.  Shed – include size # x #.

 

Lot Size ___________________                          Project Cost __________________________

 

 

 

 

 

Signature ________________________________________________ Date _____________

NOTE: THIS FORM MUST BE SIGNED PRIOR TO THE

ISSUANCE OF A BUILDING PERMIT.

 

     I, the owner/lessee of the property located at ________________________________ do, hereby, acknowledge that it is my sole responsibility to be certain as to the exact location of my property lines, as well as any easements or rights-of-way encumbering same as shown on my deed. By submitting this permit application, I am certifying that all proposed construction will be in accordance to all required setbacks, based on my verifying my property location.

 

__________________________________________________________________________

          Property Owner/ Lessee Signature                                      Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Zoning Officer Signature: __________________________________________ Date: _____________

 

Building Inspector Signature: _______________________________________ Date: _____________