MUNICIPALITY_________________________ COUNTY____________ MECHANICAL PERMIT APPLICATION INSPECTIONS AS PER ACT 45 OF THE UCC INSPECTIONS CALL 610-395-3827 EXT: 1 P.O. Box 423, Orefield, Pa. 18069 Fax 610-395-2231
TRACKING # ____________
PERMIT # ______________ DATE: _____________
Use of Structure: _________________________________________________________________ OWNER’S NAME: _______________________________________________________________ PHONE NUMBER(s): _________________________
_________________________________
CONTRACTOR: ________________________________________________________________ ADDRESS: ____________________________________________________________________ Street Number and Street Name
__________________________________________________________________ City
State
Zip
Phone #s Office: __________________ Cell: __________________ Fax: __________________
Water Heater Hot Air Furnace
Steam Boiler
Hot Water
Fireplace
Air Handler
Furnace Dryer
Other Equipment: _________________________________________________________ ________________________________________________________________________ ________________________________________________________________________
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COMMERCIAL ONLY
Lehigh Valley Inspection Services PO Box 423 Orefield, PA 18069 610-395-3827 800-431-5947