This application is made with my knowledge and approval.

Signature of Owner:

Name of Applicant (where not the owner):

Address:

Telephone number:

Name of Constructor or Builder:

Address:

Telephone Number:

Architect (s) and or Professional Engineer (s) retained to design and/or review construction of building.

Name:

Address:

Telephone:

Name:
Address:
Telephone:

Location of Proposed Building:

Location of Existing Building (s) on the site:

Describe in Detail the Proposed Building Work and Occupancy: ____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________

(Please attach extra sheets if necessary)

State the estimated value of the proposed work:

I, , hereby apply for permission to carry out the above building work. I declare that all information given by me in connection with this application is true and correct to the best of my belief and that the building work described in this application, if permitted, will be carried out in accordance with all applicable laws and regulations of the Province and the Municipality.

I understand that the granting of a permit, the approval of the drawings and specifications, or inspections made by the Municipality, shall not in any way relive me of full responsibility for carrying out the work or having the work carried out in accordance with the Municipal Building Regulations.

Date:
Signature:

Note:

This form is to be completed and submitted together with form MDA applying for a development permit and Form MBA2. (Construction details where necessary).

This application must be accompanied by the permit fee established by the Municipality.