[T!S_AN OFFENCE TO MAKE A FALSE DECLARATION

TRANSFER OF LICENCE 1/We

h

application for a transfer of Licence No.

ereby make
and

declare that the above statement of facts is correct and that |

am the owner-or manager of the said

and if |

am granted the transfer of this licence, | will comply with

bylaws of the City of Port Coquitlam.

Signature __ ‘Date /

/

| hereby agree to transfer (subject to Ci.y approval) my rights
and interest in Licence No. issued to me for the
busines known as to the above signed and

| hereby surrender my licence for this business.

Signature _Date /

/

i/We hereby apply for a licence in accordance with the
Particulars stated above and declare that these statements are
correct. | understand that if | am granted a jicence, | must
comply with the bylaws of the City of Port Coquitiam and the

provisions of Part || of the Municipal Act.

Signature Date
OFFICE. USE; .

/ 22 Status Code .

23 No. of Suites or Vend. Mach.

24 $ Billed Amount

a

SECURITY POSTED:

/

/

/ 25 Misc. Desc.
/

/

DATE OF COUNCIL RESOLUTION:

VENDING MACHINES
Type _ No. Fee | Sticker

OOnIAUMEWhA Oo.

Heating Contractor Gas Fitter Licence No.

OODO~4 Hum a UD

NO

REVISIONS

Date ‘Change

REQUIRED CERTIFICATES

Gas Fitting Contractor Provincial Licence No.
Plumbing Contractor Certificate of Qualification No.

Electrical Contractor Certificate of Competency No. A (1000)

B (2000)

C (3000)
THIEF LICENCE INSPECTOR