APPLICATION FOR DEMOLITION PERMIT
MILLCREEK TOWNSHIP, ERIE COUNTY, PENNSYLVANIA
I, _______________________________________ hereby make application for demolition of a structure at _____________________________________.
Millcreek Index No. _______________________ Co. Index No. (33) _______________________
| A. | Type of Structure: _____ Garage _____ Residence _____ Other Outbuilding (describe) _____________________ |
| B. | Method of Demolition: ____ Tear Down/Haul Away _____ Burn by _______________________ Fire Dept. |
| C. | Owner __________________________
Telephone ( ) ____________________
Address ____________________________ Zip _______________ |
| D. | Contractor
__________________________________ Telephone
( ) _____________________
Address ____________________________________________ Zip _________________ |
| E. | Notification of and releases
obtained from following:
National Fuel (Gas Co)
YES ____
NO____
GPU Energy YES____ NO____ |
| F. | Adjoining property owners have been give verbal notice _____ or written notice ______. YES____ NO____ |
| G. | All remaining debris will be removed from site within 30 days of demolition and hazardous excavations will have a protective barrier erected and must be filled in immediately after demolition. |
| H. | Township Fire Marshall has been notified. ____YES ____NO |
| I. | All Township, State and Federal Laws, Regulations and Codes will be complied with relative to demolition and disposal. |
_______________________________
___________________________200___
Signature of Owner/Authorized
Agent
Date
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DEMOLITION PERMIT
MILLCREEK TOWNSHIP, ERIE COUNTY, PENNSYVANIA
This is to certify that Millcreek Township Demolition Permit No. ____________ has been issued to _______________________________ for property at _________________________________________ as per the above application. This permit is issued on the express condition the proposed demolition conform to applicable codes regulating demolition in Millcreek Township.
____________________________________________________ Asst / Zoning Administrator & Code Enforcement Officer
Date Issued ______________________, 20 ____ Fee Paid __________________________
Date Demolished __________________________________ (for Co. Assessment records.)
NOTE: As soon as structure demolished, you must forward a copy of this permit to the Erie Co. Assessment Officer so that they may correct your assessment records. Also notification to the Millcreek Township Zoning Office is appreciated.