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SCHEDULE
OWNER’S UNDERTAKINGS
To be submitted prior to issuance of a building permit.

Date:

City of Port Coquitlam
Building Department
2580 Shaughnessy Street
Port Coquitlam. BC

V3C 2A8

ATTENTION: Director of Building Permits and Inspections
Dear Sirs:

RE: Address
Owner
Building Permit Application No.
(the "Project")

In consideration of The Corporation of the City of Port Coquitlam
accepting and processing the above application for a building permit, and
as required hy the City’s Building Bylaw, the following representations,
warranties and indemnities are given to the City.

That. I/we am/are:

the owner cf the above property; or

authorized by the owner of the Property described above to
make this application.

That I/we have authorized:

Name(s) (print)

Address(es) (print)