HomeMy WebLinkAboutGas Declaration of Compliance - Homeowner
Homeowner Gas Permit Statutory Declaration
For Single Family Dwelling Only
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City of Maple Ridge Revised 2016-10-20
11995 Haney Place, Maple Ridge, BC V2X 6A9 Tel: 604-467-7311 Fax: 604-467-7461
Inspection Requests: inspectionrequests@mapleridge.ca Web Site: www.mapleridge.ca Inquiries only at: permits@mapleridge.ca
IN THE MATTER OF AN application for a gas permit, I
(Please Print)
DO SOLEMNLY DECLARE:
THAT, I am the owner or one of the owners of lands and premises located at:
(Street Address)
THAT, I solemnly declare that said building is a "Single Family Dwelling";
THAT, I reside or intend to reside at the premises described in paragraph 2 and hereby apply for a
permit to do certain GAS work therein;
THAT, the GAS work will not be carried out by anyone other than myself or other owners of the lands
and premises;
THAT, no person shall be paid to assist me in doing the work under this permit;
AND I MAKE this solemn declaration conscientiously believing it to be true and knowing it to be of the
same force and effect as if made under oath and by virtue of the "Canada Evidence Act".
DECLARED before me at the City of Maple Ridge, in the Province of British Columbia.
Date: Registered Owner’s Signature
Witness