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APPLICATION FOR SPECIAL WRITTEN PERMIT

Pursuant te Section 4 of the

"CITY OF PoRT COQUITLAM FIRE PREVENTION BY-LAW, 1968, No. 902"
eet SESVENTION BY-LAW, 1968, No. 902"

The legal description
Zt 1s proposed to set the
site or sites thereon:

(a) Legal Description:

(b) Civic Address: 2i¢o _w# YOWER Fay
(e) Exact Location of Bovnlng Site or Sites:
; : 4 _ ) Ory ; ; —

(4)

(a) Name of Registered Owner: Lov ACL y Dé VEL OP WENT ComA
(b) Registered Owner's Consent to this Application:

Signature of Registered Owner Ft fam’ Livres

(Position with Limited Company) LEDES. ——(f applicable)

3. The days and the times of those days upon which it is proposed to
have the fire burning:

GLU om) eM

5. The methods Proposed to control or abate any. possible spread of fire
or other danger or nuisance:

L1 ACM LE RY ot AWN eS OA a MLL

PROCEDURE .
oa? ae _ 2 Zhe ;
q. Comp£ete and submit both Copies to Sigtature of Applicant

Fine Department. _
2, Fine Department Aeports on reverse Blew 2PMY mip) om LT
to City Clerk, Company Nama

side and fonvards

3. City Clerk A S26 T
Coutest neg peaees on Agenda fon Address SLesT 2 MAW
PPIRLLSS

Telephone

Qt. Y, / MW

Date of Application