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APPLICATION DATE

EAI

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AMI:

PERMIT NO,

This permit 1a iseued to the Owner/Agent named below, for the purpose of
the conatruction or demolition described herein. The validity of this
permit ia subjact to compliance with the plans and other documenta
submitted with the permit application, and to the compliance with the
"Building aad Plumbing Bylaw".

DESCRIPTION OF WORK

ADDRESS OF CONSTRUCTION

LOT
SEER,

Nane

Address

Addreaa

City

City

Postal Code

PURPOSE

Telephone Foatal Code ' Telephone

CONSTRUCTION VALUE

SIGNATURE OF
OWNER /AGENT

NOTES

PERMIT FERS AND DEPOSITS:
Permit Fae/

Per Const. Value/

Microfilm Fee

Standard Foe

Chimney Fee

Flue(e)

Sanitary Con

Connection(s)

Storm Con

‘Connectioa(a)

TOTAL FEES AND DEPOSITS:

TEE ISSUANCR OF THIS PERMIT SHALL IN NO CASE BE TAKEN AS ASSUMPTION OF —
RESPONSIBILITY BY THE CITY FOR ERRORS OR VIOLATIONS OF CODES, STATUTIS OR

BYLAWS

BUILDING
OFFICIAL