HomeMy WebLinkAboutApplication - Gas PermitRevised 2020-02-19
Date
Tax Roll No.:
GAS PERMIT APPLICATION FORM
Owner / Applicant: _____________________________________________________
Contractor:
Project Location:
Please Provide a Detailed Description of Work:
TYPE OF OCCUPANCY TYPE OF WORK NUMBER OF OUTLETS
Total:
FOIPP Notification:applications, issuing permits, safety codes complithe
Homeowner Declaration: By signing this . Journeyman’s Certification No.:
Permit Fee: $ SCC Levy: Issuing Officer’s Name:
Total Cost: $ ($4.50 or 4% of the permit fee maximum $560.00)
183037 Range Road 145 P.O. Box 130 Brooks, AB T1R 1B2
Phone: 403-362-3266 | www.countyofnewell.ab.ca