Date:
Fee Received:
Permit #:
Property Address:
Name:
Company:
Address:
City/State/Zip:
Phone:
Fax:
E-Mail Address:
Contrator's Information
Name:
Company:
Address:
City/State/Zip:
Phone:
Fax:
E-Mail Address:
License #:
Project Manager's Name:
P.M.'s Mobile Number:
Proposed Start Date:
Proposed Completion Date:
Landfill Receiving Debris:
Name:
Address:
City/State/Zip:
Phone:
Fax:
E-Mail Address:
City of Galva
311 N. W. 4th Avenue
Galva, IL 61434
Phone: (309) 932-2555
Fax: (309) 932-3306
www.galvail.gov
Demolition
Permit
Applicant's Information Owner's Information
(If different from applicant)
If "Other"
Explain:
The demolition contractor must arrange for the following with the City Clerk's office :
1. Removal of any water meters prior to demolition
2. Water service must be excavated to the corporation's fitting at the main and turned off under the supervision of the Water Super.
3. "B" box must be removed and returned to the City.
4. Sanitary Sewer Service must be excavated, capped and cemented as required under the supervision of the Water Super.
5. All other utilities must be properly terminated: Septic & Wells, Gas & Electric, Cable.
6. All the above must be completed and approved by the Superintendent of Streets before demolition begins.
7. This permit is good for thirty days.
By signing below, the contractor certifies that he/she is properly licensed for demolition work in the State of Illinois and that all required federal, state and local permits
have been obtained. The contractor further certifies that all refrigerants have been properly recovered, if any, and the $100.00 permit fee has been submitted.
Date:
Date:
Current Zone:
Type of Structure:
Relationship of Applicant to Property (select one):
Date:
Signature of Applicant:
Signature of Contractor:
Authorization to Proceed
(Street Superintendent):
