Application For Temporary Occupancy Permit printable pdf download

PPLICATION FOR

EMPORARY

CCUPANCY

ERMIT

PLEASE PRINT- APPLICANT TO COMPLETE THIS SIDE OF APPLICATION ONLY.

PROPERTY & OWNER INFORMATION

Property Address: ____________________________________________________________________

Date: ________________

Space Number: _____________

Parcel ID: _________ - _____ - _________

Ward: ________________

Owners Name: _______________________________________________________________________________________________

Address: ___________________________________________________________________

Phone: (

) _______________

City: __________________________________ State:______ Zip Code: _____________

Fax:

(

) _______________

TENANT / LESSEE / BUSINESS INFORMATION

Name: _____________________________________________________________________________________________________

Address: ______________________________________________________________________ Phone: (

) _______________

City: __________________________________ State:______ Zip Code: _____________

Fax:

(

) _______________

TEMPORARY OCCUPANCY REQUESTED (Describe in detail)

Partial occupancy as follows:

___________________________________________________________________________________________________________

REASON FOR REQUEST

___________________________________________________________________________________________________________

REMAINING WORK TO BE COMPLETED

Describe in detail the remaining work to be completed including all interior, exterior, outside parking, landscaping or any other work.

(Attach separate page if necessary)

___________________________________________________________________________________________________________

ESTIMATED DATES OF COMPLETION

INTERIOR WORK:

____________________ 20______

EXTERIOR WORK:

____________________ 20______

LANDSCAPING AND PARKING AREA IMPROVEMENTS:

____________________ 20______

TOTAL WORK COMPLETED AS ORIGINALLY APPLIED FOR:

____________________ 20______

STATEMENT OF TRUTH

COMMONWEALTH OF PENNSYLVANIA COUNTY OF ALLEGHENY

Deponent, being duly sworn, says they are the:

□

Owner of record of the property for which this application is made, and that all the statements and data furnished with this

application are true and correct.

□

Authorized agent for the owner of record of the property for which this application is made and as such has express authority to bind

such owner to all terms and conditions of any occupancy permit issued pursuant to this application, and that all statements and data

furnished with this application are true and correct.

Sworn to and subscribed before me this ______ day of _______________________ 20 ______.

_________________________________

__________________________________

Notary Public

Applicant (signature)

Applicant (printed)

NOTICE

THIS IS NOT A PERMIT. BEFORE THE SUBJECT PROPERTY CAN BE USED AS APPLIED FOR, A TEMPORARY CERTIFICATE

OF OCCUPANCY (VALID FOR THE INTERIM PERIOD APPROVED) AND/OR A FINAL OCCUPANCY PERMIT (UPON

EXPIRATION OF THE TEMPORARY CERTIFICATE) MUST BE SECURED FROM THE HOMESTEAD BOROUGH BUILDING

INSPECTION DEPARTMENT.

THE APPROVAL OF THIS APPLICATION BY THE HOMESTEAD BOROUGH ZONING OFFICER DOES NOT MEAN THE

PROPOSED USE COMPLIES WITH ANY ORDINANCE, BUILDING CODE OR LAW; OTHER THAN THE HOMESTEAD BOROUGH

ZONING ORDINANCE.

Application For Temporary Occupancy Permit

Related Articles

Related forms

Related Categories