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SCHEDULE OWNER'S UNDERTAKINGS To be submitted prior to issuance of a building permit.

Date:

City of Port Coquitlam Building Department 2580 Shaughnessy Street Port Coquitlam, BC

V3C 2A8

ATTENTION Director of Building Permits and Inspection

Dear Sirs

RE: Address Owner Building Permit Application No. (the "Project")

In consideration of The Corporation of the City of Port Coquitlam accepting and processing the above application for a building permit, and

as required by the City's Building Bylaw, the following representations,

warranties and indemnities are given to the City.

l. That I/we am/are; the owner of the above property; or authorized by the owner of the property described

make this application. he

2. That I/we have authorized:

Name(s) (print)

Address(es) (print)