Village of Perth-Andover

Electrical Waiver Form

OWNER

First Name

Last Name

Street Address

City

State/Province/Region

Postal/Zip Code

Phone

ELECTRICIAN

Name

Phone

Scope of Work

Projected Start Date

APPLICANT

I understant that as no building permit is issued, no renovation, addition, alteration, new construction or change of use is to occur to the structure, building or equipment servicing the building for which the electrical equipment or wiring is being provided. this is not to be considered as zoning approval.

Yes

Firstname

Lastname

By checking this box I agree that I will send an etransfer in the amount of $25 to info@perth-andover.com immediately after I hit submit or send payment to 1131 West Riverside Drive, Perth-Andover, NB, E7H 5G5. Failure to do so will result in this application not being processed.

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Electrical Waiver Form

OWNER

ELECTRICIAN

APPLICANT

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