Since reforms carried out in the late 1970s, China has experienced unprecedented rates of urban growth. Remote sensing data and surface observational data are used to investigate the urbanization process and related environmental consequences, focusing on extreme heat events and air pollution, in Zhejiang Province (ZJP, East China). Examination of satellite-measured nighttime light data indicates rapid urbanization in ZJP during the past decade, initially forming three urban clusters. With rapid urban sprawl, a significant Urban Heat Island (UHI) effect has emerged. During extreme heat events in summer, the UHI effect significantly exacerbates nocturnal heat stress in highly urbanized areas. Taking a long-term view, urbanization also causes additional hot days and hot degree days in urban areas. Urbanization also imposes a heavy burden on local and regional air quality in ZJP. Degraded visibility and an increase in haze days are observed at most meteorological stations, especially in the three urban clusters. The results show that urbanization has led to serious environmental problems in ZJP, not only on the city scale, but also on the regional scale. Maintaining a balance between the continuing process of urbanization and environmental sustainability is a major issue facing the local government.