Fillable 18004 APPLICATION FOR CONSTRUCTION PERMIT (Libertyville)

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18004 APPLICATION FOR CONSTRUCTION PERMIT (Libertyville)

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The 18004 APPLICATION FOR CONSTRUCTION PERMIT (Libertyville) form is 1 page long and contains:

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  • 27 check-boxes
  • 23 other fields

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File type: PDF

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APPLICATION FOR ENGINEERING PERMIT
VILLAGE OF LIBERTYVILLE
Public Works Department
Phone: (847) 918-2100 200 E. Cook Avenue, Libertyville, IL 60048 Fax: (847) 918-9439
www.libertyville.com/engineering Email: engineering@libertyville.com
Project Site Address
Work Description:
Would you like to be contacted via email? Yes No
Provide email address below for more efficient communication.
Name
Street Address City Zip
Contact Information
Property Owner
Phone:
Fax:
Email:
Contractor
Phone:
Fax:
Email:
Applicant
Phone:
Fax:
Email:
WORK ITEMS: (Check all that apply)
□ Excavation and/or Fill
□ Grading/Surface Drainage
□ Storm Sewer/Sump Pump Service
□ Sanitary Sewer/Service
□ Water Main/Service
□ Access Drives & Aprons/ Parking Lot
□ Street Pavement
□ Curb & Gutter
□ Sidewalks/Walkways/Bikepaths
□ Stormwater Detention/Modification
□ Street/Area Lighting
□ Landscaping/Berming/Plantings
□ Tree Removal
□ Traffic Control/Signage/Markings
□ Irrigation System
□ Erosion Control
□ Flood Plain Management
□ Recreation Facilities/Park Enhancements
□ Impervious Surface Changes
□ Other __________________________________________
_______________________________________________
□ Work in the Public Right Of Way
All information provided herein is true and correct, and all provisions of the
“Engineering Permit Conditions” and all ordinances of the Village of Libertyville shall
be complied with. I hereby certify that the proposed work is authorized by the owner of
record and that I have been authorized by the owner to submit this application as
his/her agent.
Applicant Statement
Print Name of Applicant
Contractor
Signature of Applicant
Date
OFFICE USE ONLY:
APPROVED BY:
APPROVAL DATE:
PERMIT NO:
January 2020 S:\Building\mac\Forms Procedures & Labels\Engineering Permit App 2020.doc
This Box For Office Use Only
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18004 APPLICATION FOR CONSTRUCTION PERMIT (Libertyville)

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Completed 12 July 2021

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