ACCREDITED SERVICES, INC PO Box 127   Waynesboro, PA 17268
717-762-7065    Fax 717-762-5333
BUILDING PERMIT APPLICATION
PROPERTY
INFORMATION		 Site Address:
 Municipality:
OWNER'S
INFORMATION		 Name:
 Address:
City, State:
 Phone:
APPLICANT'S
INFORMATION		 Name:
 Address:
City, State:
 Phone:
BUILDING PERMIT INFORMATION
Residential   Commercial   New   Other Estimated Finished Value: $
Estimated Construction Duration: Weeks Sq Ft Floor Area Change:
Describe Work:
If ADDITION or NEW CONSTRUCTION, number of bedrooms: and bathrooms:
Check all that apply:   Footers   Electric   Plumbing   Heating and/or AC
Zoning/Land Use Permit Number: (if required)
CONTRACTING
COMPANY		 Name:
 Address:
City, State:
 Phone:
Project Supervisor's Name:
 Cell Phone:

Contact Name:

Contact Phone:

Contact Email:


A Code Official will contact you for additional required information.

FOR SECURITY PURPOSES, YOUR IP ADDRESS (38.107.191.84) HAS BEEN RECORDED