Waiver Form - City Of Edmonton

DEVELOPMENT SERVICES (HSBC Bank Place)

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5

FLOOR, 10250 - 101 STREET NW

EDMONTON, AB T5J 3P4

PHONE: 311 or if outside of Edmonton 780-442-5311

EMAIL: developmentservices@edmonton.ca

WAIVER

Development Permit Application

Project No.: _____________

Date: ______________

I, the applicant, acknowledge that if the above noted application is approved by the

Development Officer, that the decision may be appealed to the Subdivision and Development

Appeal Board by any persons affected by such a decision, if such an appeal is made within

fourteen (14) days of receipt of notice of the Development Officers decision.

I agree to assume all the risks and waive any right to compensation due to my requirement to

proceed with the development prior to the expiry of the appeal (notification) period.

I understand that I can not proceed with construction of this project without the required

Building Permit and hereby request that it be issued so I may proceed at my risk.

______________________________

Signature of Applicant

_______________________________

_______________________________

Name & Company/Firm

(Please Print)

Personal Information required by City of Edmonton application forms is collected under authority of sections 33(a) and (c) of the Alberta Freedom of Information and Protection of Privacy (FOIP) Act. Your

personal information will be used to process your application(s). Please be advised that your name, address and details related to your permit may be included on reports that are available to the public as required

or allowed by legislation. If you have any questions, please contact a Service Advisor at the Permits and Licensing Service Centre at 780-442-5054.

July 2016