4. Present Zoning of the Property is

I hereby declare that all the above statements and the information contained
in the material submitted in support of this application are to the best of
my belief true and correct in all respects.

(Applicant's Signature)

Telephone No.

I/We consent to the making of this application:

(Owner's Signature)

Telephone No.

TO BE COMPLETED BY THE CITY OF PORT COQUITLAM

Date of Application:

Building Permit Required:

Fee Payable:

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