Date:
Permit Number:
Plan Check #:
Project Address:
Name:
Address:
City/State/Zip:
Phone:
Fax:
E-Mail Address:
Project Contact:
Address:
City/State/Zip:
License Number:
Company Name:
Address:
City/State/Zip:
Proposed Use of Building:
License Number:
Name:
Company:
Address:
City/State/Zip:
Phone:
Fax:
E-Mail Address:
Phone:
Fax:
E-Mail Address:
License Type:
Phone:
Fax:
E-Mail Address:
Current Use of Building:
The City of Galva may require written approval from the owner
City of Galva
311 N. W. 4th Avenue
Galva, IL 61434
Phone: (309) 932-2555
Fax: (309) 932-3306
www.galvail.gov
Building Permit
Application
Property Owner
Contractor
NONRESIDENTIAL
Addition to Existing Alteration/Repair Demolition RelocateNew Construction
Owner - Builder
RESIDENTIAL
Tenant Architect Designer Engineer
Purpose of Application
Page 1 of 2
Zone:
Description of
Proposed Work
(Example: I am
adding a 14' X
16' office space
to an existing
structure).
Attach drawing
or plans
detailing the
proposed work
To be installed, but not included in the above cost:
For Demolitions Only
Office Use Only
I hereby certify that the proposed work is authorized by the owner of record and that I have been
authorized by the owner to make this application as his/her authorized agent and I/we agree to conform
to all applicable laws of this jurisdiction and those of the State of Illinois and the Federal Government.
For demolitions, all of the above must be completed to the satisfaction of the City BEFORE demolition
begins. Applicant or contractor(s) must acquire all necessary EPA and IEPA permits that are required, if
any. Demolitions must be completed within thirty days of permit issuance.
Page 2 of 2
Plan Check Required?
Route To:
Hazardous Materials? Variance Required?
Planning Approval? Zone Change Required?
Soils Report Required? Tapping Fees Required?
Grading Plans Required?
Cost of Improvement (labor + materials + overhead + profit) Rounded to Nearest Dollar:
Building Permit Number (from page 1)
Date Permit Issued:
Calculated Building Permit Fee:
Approved by:
Electrical
Yes
Yes Yes
Yes
Yes
Yes
Yes
Yes
Residential Plan Checker Commercial Plan Checker Streets
Planning Engineering/Grading Zoning
Water/Sewer Dept. Other________________Fire
No
No No
No
No
No
No
No
Superintendent of Streets Notified? Arrangements made for removal of water meter prior to demolition?
Water service excavated to fitting at the main and turned off under the inspection of the Water Superintendent?
"B" box removed and returned to the City?
Sanitary sewer service excavated, capped and cemented as required under the inspection of the Water Superintendent?
Plumbing HVAC Other (elevator, etc.)
Signature of Applicant: Date:
Notes:
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