SCHEDULE |

THE CORPORATION OF THE CITY OF PORT COQUITLAM

BYLAW NO. 1298

APPENDIX "0"

RELEASE, INDEMNIFICATION AND REMOVAL STATEMENT

1, the undersigned, being the registered owner of that certain parcel of tand
-gituate in Port Coquitlam, British Columbia which is municipally described as:
Street
Address:
‘and more particularly described as:

Legal
Description:

(the "Lands!)

a Plan of Subdivision of which was accepted for deposit at the New Westminster

Land Title Office on the day of » 198 under No.

(the "Plan') have made application for a building permit in respect thereof.

In consideration of the City granting my application fer a building permit for
the Lands prior to completion of deposit of the Ptan by the New Westminster Land
Title Office, | hereby RELEASE, INDEMNIFY and SAVE the City HARMLESS from and
against any and all claims, actions and losses whatsoever, whether known or

unknown, which have arisen or may arise, either directly or indirectly, from the

issuance of this building permit by the City to me.

if the Plan is either rejected or for any reason the deposit of It ts not

completed at the New Westminster Land Title Office within six months of the date

of issuance of the building permit, the permit will forthwith thereafter be void

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