UCC-4 APPLICATION FOR DEMOLITION PERMIT

UCC 4 Form

Check that applies

EXPEDITE REVIEW. ADDITIONAL FEE SUBMITTED.

ACT 24 EXEMPTION

Political Subdivision and County names are required.

Facility Name (name of company, mall, institution, university, etc.):

Building and/or Tenant Name

Street Number and Name

City

State

Zip Code

Political Subdivision

County

Contact Name

Phone

File Number (if approved for occupancy by L & I)

Location of all buildings or structures to be demolished, distances to property lines and distances to sidewalks, pavement and curbs where they abut property lines.
Location of any existing buildings or structures that will remain on the site.
Area to be filled to existing grade and seeded or to be fenced and otherwise protected in anticipation of new construction.
If applicable, location, dimensions and construction details for pedestrian protections required in section 3306 of the International Building Code.

Applicant Name

Street Address

City

State

Zip Code

Phone

Fax

Owner Name

Street Address

City

Zip Code

Phone

Name

Date