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APPLICATION WORM FOR A BUXLDING ROVING PERIT

APPLICATION DATE:

I/We hereby make application under the provisions of the pertinent Bylawa for
permigaion to move the following building and agree to all tha requirements of
the said Bylawe in force in the Municipality end to indemalfy and keep
harmless the Municipality againat all claims, liabilities, judgemants, costes
end expenses of whatever kind, which may in any way accrue against the said
municipality in consequence of, and incidental to, the granting of this
Permit, if issued.

ately
Aran
ae

BUILDING SITE ADDRESS (moved from):
PARTIAL LEGAL DESCRIPTION: Lot #
BUILDING SITE ADDRESS (moved to) :
PARTIAL LEGAL DESCRIPTION: Lot #
TYPE OF CONSTRUCTION Floor area
CARER, COATERACTIO ain

Nae Name sit

Addxesea Address

City City

Postal Code Telephone/Fax Postal Code | Telephone/Fax

Assessed Value of Building Use of Proposed Building:

$_ Residential
Commercial

Specify All Existing Buildings on Lot Industriel =.
Institutional.

Occupancy Use: (specify)

AXKRKAARAR AAA HWW ew

WORFICK URE ORLY
*Permit No.?
*
*Zoning :
r" APPLICANT
“Fee Paid: CHC)
*

*Raceipt : Be Q(.) Bt) AC_)* Name
*

“Comments % r

" w

w ¥ Telephone/Fax
PY
*

Signeture

*
ARARAHRRANKHRA HK HE KWH