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THE CORPORATION OF THE CITY OF PORT COQUITLAM

"DEVELOPMENT PROCEDURES BYLAW, 1987, NO. 2243”
SCHEDULE "A" :
Enacted by Bylaw No. 2608

APPLICATION FOR
REZONING
. OR
LAND-USE CONTRACT AMENDMENT/ CANCELLATION

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TO BE COMPLEYED BY APPLICANT - Please print clearly FILE NO.

Applicant's Name Registered Owner:

Address Address

(include postal code) (include postal code)

Phone Number . Phone Number

Legal Description of Property

Street Address

Change Requested - (a) From Zone _ to Zone
(b) Other Change
Note: if subdivision is required please contact the Engineering Dept.

Present Use of Property

(Describe Buildings)

Proposed Use of the Property

(Describe New Construction Planned)

Size of Property

Y/We declare that our interest in the property described above is as follows:

Initials

Registered Owner or Purchaser under Registered Agreement for Sale
Holder of a Registered Option to Purchase ’ ;

Holder of .

I am the agent of who holds the
interest I have indicated above.

(Date) | | (Signature)

TO BE COMPLETED BY OFFICE
Non-refundable Fee

Fee for newspaper advertising and mailing © . 1,200.00
(refundable if Public Hearing is not held)

TOTAL FEE PAID

RECEIPT # DATE