DOUGLAS COUNTY BUILDING PERMIT APPLICATION MAKE CHECK PAYABLE TO: DOUGLAS COUNTY

RETURN TO: DOUGLAS COUNTY SUPERVISOR OF ASSESSMENTS

401 S. Center, Room 103

Tuscola, IL 61953

217-253-3031 INCOMPLETE APPLICATIONS WILL DELAY

APPROVAL OF THIS APPLICATION.

Owner’s Name: ____________________________________________________Phone: ____________________________________

Mailing Address: ______________________________________________________________________________________________

Builder’s Name: ____________________________________________________Phone: ___________________________________

Address of Proposed Construction: ______________________________________________________________________________

Parcel Identification Number (PIN): _____________________________________________________________________________

Legal Description (Only if parcel number is not available): ___________________________________________________________

Setback from center of road:__________________________________________________(Must be submitted by owner or builder)

Estimated cost of construction: $_______________________________________________(Must be submitted by owner or builder)

Proposed Use:

Residential

Farm

Commercial

Industrial

Other: ______________________

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Foundation:

Concrete Slab

Crawl Space

Cement Block

Basement

Full

1/2

1/4

Type of Construction:

New Building

Addition

Alteration/Remodel

Repair/Replacement

Other: ______________________

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Foundation (cont’d)

Basement Finish

Recreational

Living Quarters

Full Finished

1/2 Finished

1/4 Finished

No Finish

Dimensions & Plumbing

Length X Width

Total Square Feet =

Number of Stories

Number of Full Baths

Number of ½ Baths

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Heating & Air Conditioning

Gas Forced Air

Electric

Radiant

Floor

Hot Water

Geo-Thermal

Central Air Conditioning

Permit #: _________________________Fee:$______________

Date Issued: _________________________________________

Expiration date, one year from date issued

Flood Plain: Yes No

ADMINISTRATIVE USE ONLY

Outer Wall Materials

Vinyl Siding

Aluminum Siding

Brick

Stone

Metal

Wood

Other _________________________

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Interior Wall Finish

Drywall

Paneling

Metal

No Finish

Wall Height ________________

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Garages

Attached

Detached

Frame

Brick

Metal

Frame

Wood

Steel

Concrete

Pole

Other__________________________

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Fireplace

Pre-Fab

Masonry

Other_________________________

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Decks

Length X Width

Wood

Vinyl

Roof

Asphalt Shingle

Metal

Tile

Tar and Gravel

Gable

Hip

Flat

*******************************

Porch

Length X Width

Front Rear Si

Side

*******************************

Patio

Length X Width

Front Rear

Brick

Concrete

**The building permit must be approved prior to construction. You will be notified of approval or denial.

** If this parcel is in a designated floodplain additional forms may need to be completed and approved by the Federal Emergency

Management Agency and/or The Department of Natural Resources.

**Incomplete applications will delay approval of the building permit.

**Make check payable to Douglas County and Return to: Supervisor of Assessments, 401 S. Center, Room 103, Tuscola, IL 61953

I/We, the undersigned, being the owner (s) or contractor of above described property; certify the proposed construction will

comply with all applicable laws, codes, ordinances, and regulations of Douglas County.

Signature of owner (s) or contractor: _____________________________________________________Date: _____________________

Building permit Administrator signature: __________________________________________________Date: ____________________