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Sign Permit

APPLIC. DATE PERMIT NO.

This permit is issued to the Owner/Builder named below, for the purposes of Plumbing or related work described herein,

h the permit application, and to the compliance with the "Port Coquitlam Building and Plumbing Bylaw".

ADDRESS

LOT ZONING

ORNER BUILDER

(name) (name )

(address) (address)

(city) (city)

(postal code) (phone #) - (postal code) (phone #)

PURPOSI: CCCURANCY

CONSTRUCTION VALUE

SIGNATURE OF OANER/AGENT

PERMIT FEES AND DEPOSITS: Sign Micro Fee Sign Permit Fee Per Sign Value

TOTAL FEES AND DEPOSITS

THE ISSUANCE OF THIS PERMIT SHALL IN NO CASE BE TAKEN AS ASSUMPTION oF RESPONSIBILITY BY THE CIty FOR ERRORS OR VIOLATIONS OF CODES, STATUTES

BYLAWS BUILDING OFFICIAL DATE RELEASED