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Required fields are marked with asterisks (*)

Welcome

Please complete this form if the Legal Owner is not requesting the information

Name of legal owner

Property Address

Municipality

Name of the person you are authorizing to request property information.

Email:

Name of the Company authorized to request property information (if applicable)

I am authorizing this person to act as my agent pertaining to the above property, with respect to the following:

To receive detailed information regarding Zoning and information regarding other applicable law as it pertains to applying for a permit listed below. (ORCA, Heritage, Source Water Protection)

To apply for and obtain a building or demolition permit, sign, plumbing or pool permit

Applying for a Community Improvement Plan Grant

Other matters (please specify and attach a separate sheet if necessary)

Please indicate whether this authorization has a limited time frame.

Yes

Signature (legal) Owner

Clear

Date