ACCREDITED SERVICES, INC PO Box 127   Waynesboro, PA 17268
717-762-7065    Fax 717-762-5333
Permit Appl Date: 05/18/2012 10:15:18
BUILDING PERMIT APPLICATION
Description of Work:  
PROPERTY
INFORMATION		 Site Address:
 Municipality:
OWNER'S
INFORMATION		 Name:
First:
Last:
Address:
City/State:
 Phone:
APPLICANT'S
INFORMATION
Same As Owner		 Name:
First:
Last:
Address:
City/State:
 Phone:
BUILDING PERMIT INFORMATION  
Permit Type Estimated Cost:  $
Estimated Construction Duration: Weeks Sq Ft Floor Area Change:
Describe Work:   
If ADDITION or NEW CONSTRUCTION, NUMBER OF     BEDROOMS:      BATHROOMS:
Check all that apply:      FOOTERS   ELECTRIC   PLUMBING   HEATING and/or AC   RESCHECK?  
Zoning/Land Use Permit Number: (if required)
CONTRACTING
COMPANY
Same As Owner
Same As Applicant		 Name:
 Address:
City/State:
 Phone:
Project Supervisor Name
 Cell Phone:

Contact Name:
Same As Owner
Same As Applicant

Contact Phone:

Contact Email:


A Code Official will contact you for additional required information.

FOR SECURITY PURPOSES, YOUR IP ADDRESS (38.107.179.239) HAS BEEN RECORDED