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SCURDAILE
APPLICATION FORM FOR A BUILDING MOVING PERMIT

APPLICATION DATE:

I/We hereby make application under the provisions of the pertinent Bylaws for
permission to move the following building and agree to all the requirementa of
the said Bylawa in force in the City and to indamnify and keep harmleas the
City againet all cleimsa, liabilities, judgements, costa and expenses of
whatever kind, which may in any way accrue against the aaid City in
consequence of, and incidental to, the granting of this Permit, if issued.

BUXLDING SITE ADDRESS (moved from):.
PARTIAL LEGAL DESCRIPTION: Lot # Plan #
BUILDING SITE ADDRESS (moved to) :
PARTIAL LEGAL DESCRIPTION: Lot # Plan #.

TYPE OF CONSTRUCTION Floor area Age
GHGER

Naune | Name

Address Address

City City

wre
Meee

Postal Code Telephone/Fax Postal Code felephone/Fax

Assessed Value of Building Use of Proposed Building:

$ Residential OO
Commercial oun

Specify All Existing Buildings on Lot Industrial
Institutional

Occupancy Use: (specify)

Hea N KR Re RHM KR HRA HH KH

*OFFICE USK OWLY

*Permit No.:
k

*Zoning:

* ' APPLICANT
*Fee Paid: CHC) CAC )*
*

to
*Receipt : Bit OC) BC) Name
*

*Comments : Signature

*
* Telephone/Fax

*
ax ke KWH Ae KR KK — TEM