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AMA

LER
. 4 al
eee Seater

I hereby declare that all the above Statements and the infurmation contained in

the material submitted in support of thig application are to the hest of my
belief true and correct in all respects.

io _
Me fXWTECT og,
ene ae ne
(Applicant's Sioature)
TRIWING HOLDINGS LTD.

per William Baird, President :

294~1112 :
(Telephone Na.)

.

consent to the making of this application:

ecceneeme | aened FON came

ore ove om femme es ve r
\

ae . ‘

(Owner!

3 Signature)

(Telephone No.)

TO BE COMPLETED SY THE CITY OF PORT COQUITLAM

Date of Application:

Building Permit Required

Fea Payable:

RS
4