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.
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Plan Check Required?
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:
Residential Plan Checker Commercial Plan Checker Streets
Planning Engineering/Grading Zoning
Water/Sewer Dept. Other________________Fire
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: