1T_IS_AN OFFENCE TO MAKE A_FALSE DECLARATION

TRANSFER OF LICENCE |/We hereby make
application for a transter of Licence No. 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, j will comply with’
bylaws of the City of Port Coquitiam.

Signature ” ' Date” ~ / /

| hereby agree to transter (subject to City approval) my rights
and interest in Licence No. issued to me tor the
busines known as to the above signed and

| hereby surrender my licence for fhis business.

Signature Date / /.

|/We hereby apply for a fticence In accordance with the
Particulars stated above and declare that these statements are
correct. ! understand that i¢ | am granted a licence, ! must
comply with the bylaws of the City of Port Coquittam and the
provisions of Part || of the Municipal Act.

Signature . _Date
OFFICE USE;

REVISIONS
/ 22 Status Code

“Date Change

23 No. of Suites or Vend. Mach.

24 $ Billed Amount

weer

SECURITY POSTED:

/

/

/ - 25 Misc. Desc.
/

/

DATE OF COUNCIL RESOLUTION:

TS

OOF MN AWA OX

VENDING MACHINES
Type No. Fee . Sticker

CVG VOUAaUN —

REQUIRED CERTIFICATES

_
—_

12
Heating Contractor Gas Fitter Licence No.
Gas Fitting Contractor Provinclal Licence No.
Plumbing Contractor Certificate of Qualification No.
Electrical Contractor Certificate of Competency No. A (1000)
B (2000)
C (3000)

CHIEF LICENCE INSPECTOR 1257
4 24