COMMERICAL BUILDING PERMIT APPLICATION

VILLAGE OF GLENWOOD
COMMERCIAL BUILDING PERMIT APPLICATION ONE ASSELBORN WAY, GLENWOOD, ILLINOIS 60425 PHONE (708) 753-2416 FAX 708-753-2406
Date of Application

MonthDayYear
Date
Permit No
Permit Cost
Owner of Property
Phone No.
Project Address
Owner of Business
Phone No.
Type of Business
USE AND OCCUPANCY CLASSIFICATION:
TOTAL PROJECT COST
Business-B Factory-F-1 F-2 Mercantile-M Residential R-1 R-2 R-3 R-4 Utility U Fire Safety Sprinkled CONTRACT INFORMATION (please list all contractors on the next page)
General Contractor
Phone
Address

Address

Street Address Line 2

CityState

Postal / Zip Code
Phone
Building
Electrical
Plumbing
Fire Safety
I HEREBY CERTIFY THAT THERE ARE NO WILLFUL MISREPRESENATATIONS IN, OR FALSIFICATIONS OF THE INFORMATION WRITTEN IN THIS APPLICATION. I AM AWARE THAT SHOULD INVESTIGATION DISCLOSE ANY FALSIFICATION, I MAY BE SUBJECT TO A FINE. ANY ENGINEERING FEES BILLED TO THE VILLAGE OF GLENWOOD FOR SITE WORK OR SITE INSPECTIONS, AFTER OCCUPANCY IS ISSUED, WILL BE THE RESPONSIBILITY OF THE OWNER/APPLICANT AND PAID TO THE VILLAGE OF GLENWOOD UPON THE RECEIPT THEREOF, ALL WORK MUST BE DONE IN ACCORDANCE WITH THE CODES OF THE VILLAGE OF GLENWOOD.
Signature of Applicant

Clear
Date

MonthDayYear
Date
Building Department
Date

MonthDayYear
Date
COMMENTS
CONTRACTOR INFORMATION: All contractors must be licensed by the Village of Glenwood
Trade
Name
Address
Phone
Licensed
Trade
Name
Address
Phone
Licensed
Trade
Name
Address
Phone
Licensed
Trade
Name
Address
Phone
Licensed
Trade
Name
Address
Licensed
Licensed
Trade
Name
Address
Phone
Licensed
Trade
Name
Address
Phone
Licensed
Trade
Name
Address
Phone
Licensed
Trade
Name
Address
Licensed
Licensed
Trade
Name
Address
Phone
Licensed
Should be Empty:

VILLAGE OF GLENWOOD

COMMERCIAL BUILDING PERMIT APPLICATION ONE ASSELBORN WAY, GLENWOOD, ILLINOIS 60425 PHONE (708) 753-2416 FAX 708-753-2406

USE AND OCCUPANCY CLASSIFICATION: