Health & Life Safety Manual - Electronic Resource Center

This application is to befilled out for eachamendment beingappealed, and maycontain multiple items ofthe amendment.APPLICATION FOR APPEALOF DENIEDHEALTH/LIFE SAFETY ITEMSAMENDMENT NUMBER:AMENDMENT DATE:1. COUNTYCODE/NAME:2. DISTRICT CODE/NAME: 3. SITE CODE/NAME: 4. FACILITY CODE/NAME:5.ITEMI.D.:6. LOCATIONNAME(S) & ROOMNUMBER(S):DESCRIPTION OF THE PROBLEM AS IT APPEARS ON FORM 35-47; ITEM 9&SPECIFICATIONS AS IT APPEARS ON FORM 35-48; ITEM 8:Additional appeal items may be continued on a separate page. ATTACH A COPY of the form -Certificate of Approval for the Expenditure of Fire Prevention and Safety Fund in question (Form 35-22)School board has the power to levy a tax or to borrow money and issue bonds for fire prevention, safety, energyconservation, disabled accessibility, school security, and specified repair purposes. § 105 ILCS 5/17-2.115.ITEMI.D.:DESCRIBE THE BASIS UPON WHICH THE BOARD OF EDUCATION IS SEEKING THE APPEAL:AUTHORIZATION:DateSignature of District SuperintendentName of Architect/EngineerSignatureName of Firm Phone Number (Seal)License NumberExpiration DateRECOMMENDATION BY REGIONAL SUPERINTENDENT:c APPROVEc DISAPPROVEDateSignature of Regional SuperintendentRECOMMENDATION BY STATE BOARD OF EDUCATION:c APPROVE (See Revised Certificate of Approval)c DISAPPROVE (See Attached Letter)DateForm 35-51 (3/04) (Prescribed by ISBE for local board use)ISBE Authorization to Proceed:Page _______ of _______4-25