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APPLICATION DATE PERMIT NO.

This permit is iasued to the Owner/Agent named below, for the purpoge of
the construction or demolition described herein. The validity of this
permit ia 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

ADDKESS OF CONSTRUCTION

ney
ied
J

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ty

LOT
CARER

Name

Address Address

City City

Postal Code Telephone Postal Code Telephone

PURPOSE

CONSTRUCTION VALUE

SIGNATURE OF N&Mz
OWNER /AGENT
TELEPHONE

NOTES

PERMIT FEES AND DEPOSITS:
Permit Fee/ Per Conat. Value/
Microfilm Fee | Standard Fee

Chimney Fee Flue(s)
Senitary Con | | | Connection(s)

Stoxm Con - Connection(a)

TOTAL FERS 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
OFFICIAL

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