Building Permit Application

Village of Lansing

Cook County

3141 Ridge Road Lansing, Illinois 60438

BUILDING PERMIT APPLICATION (SMALL PROJECT)

JOB SITE ADDRESS: PERMIT #: ______

PROPERTY OWNER: PHONE #: ______

ADDRESS (IF DIFFERENT FROM JOB SITE):

DESCRIPTION OF WORK: ______

VALUE OF WORK INCLUDING MATERIALS AND LABOR______

CARPENTER:______PHONE:______CONCRETE:______PHONE:______ELECTRICAL:______PHONE:______FENCE:______PHONE:______HEATING: ______PHONE:______MASONRY______PHONE:______PLUMBING:______PHONE:______ROOFING:______PHONE:______SIDING/GUTTERS:______PHONE:______WINDOWS:______PHONE:______OTHER CONTRACTOR______PHONE:______

I HEREBY CERTIFY THAT ALL THE INFORMATION PROVIDED HEREIN IS TRUE

SIGNATURE: DATE:

Permit Fee: $______Post Hole: $______Final Plumbing: $______Elec. Service: $______Pre-Pours: $______Service Charge: $______Rough Framing $______Sewer/Water: $______Late Fee: $______Rough Electric $______Final Building: $______Security Deposit: $______Rough Plumbing $______Final Electric: $______TOTAL: $______