NOTE Owner must sign this form submission below
Click or drag a file to this area to upload.

Disclaimer and Consent

I hereby certify that I am the owner of record, or that I have been authorized by the owner of record to make this application for the proposed work, and I understand and assume responsibility for the establishment of all official property lines, right-of-way areas, and easements prior to the commencement of any project or construction. Further, I certify that all information provided in this application and all accompanying documentation is true and correct to the best of my knowledge, subject to the penalties of 18 Pa.C.S.A 54904 Unsworn Falsification to Authorities, and shall conform to all applicable local, state, and federal laws governing the execution of this project. I understand that failure to comply with applicable laws and regulations, omission or misrepresentation of facts, or change in findings may result in the immediate revocation of any granted approvals. I hereby grant permission to the Code Official and/or his/her representative to enter the property or areas in which work is being conducted within the scope of this requested permit, at any reasonable hour, to perform inspections for compliance and to enforce the provisions of all applicable Codes governing this project.
Clear Signature
NOTE: If an agent is acting on the owner's behalf, a signed statement granting permission to said agent must be signed, dated, and submitted at the Borough office.