Required fields are marked with asterisks (*)

Property Authorization Form for Building Applications

I/We

Hereby authorize

Representative for

To act as my agent to apply for a building permit for the property located at

Property Owner Address

Phone Number

Date

Signature

Clear

Privacy Statement: Personal information on this form is collected under the authority of the Municipal Act 2001 P.S.O. c45. The information will be used for the purpose of processing permits. Questions about the collection of this information can be directed to the Manager of Legislative Services/Clerk, Municipality of Leamington, 111 Erie Street North, Leamington, Ontario, N8H 2Z9, Telephone: 519-326-5761

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