Y,
oé
ined

woe
Vay gh Uh 2)
re ye
RP
hits ee,

APPLICATION FORM FOR A BUILDING PERHIT

APPLICATION DATE:

I/We hereby make applicatio# and provide plans\under the provisions of the
pertinent Bylaws for permis ein 4 8 alk a0 eee~Pepair or alter the following
building or structure and agree to comply with all the requirements of the
gaid Bylaws and to indemnify and keep harmless the Municipality against all
claims, liabilities, judgements, costs and expenses of whatever kind, which
may in any way accrue againet the said municipality in consequence of, and
incidental to, the granting of this Permit, if iasued. |

BUILDING SITE ADDRESS:

PARTIAL LEGAL DESCRIPTION: Lot # Plan #

Address Address

City City

‘Poetal Code Telephones Fax Postal Code Telephone

Renovate Use of Proposed Building:

Estimated Construction Value: Residential
$ Commercial
Industrial

Existing Buildings on Lot? (specify) Institutional

Occupancy Vee: (specify)

AURAL RRA ALAR ARAN

$ f We do not plan review at the
counter. Incomplete drawings may
delay your permit application. Your
signature acknowledges your
acceptance of this policy.

*Fee Paid:
*

Receipt bt
*

*Comments :
*
*
a