Occupancy Permit Application

THE TOWN OF KIPPENS $10.00
2 Juniper Avenue, Kippens, NL A2N 3H8
APPLICATION FOR OCCUPANCY PERMIT
NAME OF APPLICANT/TENANT/OWNER______________________________________________
PREVIOUS ADDRESS OF APPLICANT ________________________________________________
__________________________________________________________________________________________________________________________________________________________________________
NUMBER OF OCCUPANTS ADULTS __________________________________
CHILDREN ________________________________
NAME OF OWNER OR REPRESENTATIVE _____________________________________________
ADDRESS OF OWNER ____________________________________________________________
_________________________________________________________________________________________________________________________________________________________
TELEPHONE No. OF OWNER ______________________________________________________
I hereby make application to occupy ________________________________________________
Constructed under the permit No. ______________________________________(if applicable)
I hereby declare that to the best of my knowledge, this ________________________________
has been constructed in accordance with the approved plans, the National Building Code of Canada, and the conditions of Permit No. ___________________________________________.
The granting of this permit shall not relieve the owner/or the developer from completing all remaining work in accordance with the approved plans and specifications and all Regulations.
Dated at ____________________ this ________ day of _________________ 20_______
____________________________________
Applicant’s Signature
To be completed by town office
OCCUPANCY PERMIT NO. ____________________ DATE OF ISSUE ______________________
The Town of Kippens hereby permits the occupancy of the building at _____________________
For the occupants set out above in accordance with the terms and conditions of the permit issued to the applicant.
________________________________________________
Town Official