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BUILDING PEYMIT

APPLICATION DATE PERMIT NO.

This permit is issued to the Owner/Agent named below, for the purpose of
the construction or demolition described herein. The validity of this
permit is subject to compliance with the plans and other documents
submitted with the permit application, and to the compliance with the
"Building and Plumbing Bylaw".

DESCRIPTION OF WORK

ADDRESS OF CONSTRUCTION

LOT ZONING

OTE

Name

Address Address

City City

Postal Code Telephone Postal Coda Telephone

PURPOSE

CONSTRUCTION VALUE

SIGNATURE OF NAME
OWNER/ AGENT TELEPHONE

NOTES

PERMIT FEES AND DEPOSITS:

Permit Fee/ Per Const. Value/
Microfilm fee Standard Fee

Chimney Fee Flua(s)
Sanitary Con Connection(s)
Storm Con Connention(s)

Engineering Fee(s) Total ree(s)

TOTAL FEES AND DEPOSITS:

THE ISSUANCE OF THIS PERMIT SHALL IN NO CASE BE TAKEN AS ASSUMPTION OF
RESPONSIBILITY BY THE CITY FOR ERRORS OR VIOLATIONS OF CODES, STATUTES OR

BYLAWS

BUILDING DATE

OFFICTAL ISSUED

2735
22

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