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unofficial consolidation, the official version is held by the municipal clerk.
Town of Smoky Lake
PO Box 460
56 Wheatland Avenue
SMOKY LAKE AB T0A 3C0
Phone: 780 656 3674
www.smokylake.ca
BUILDING PERMIT APPLICATION FORM
Application Date:
Estimated Project Completion Date:
Applicant Type:
Homeowner
Contractor
Cost of Installation (Market Value Including Equipment) $
The Permit Holder hereby certifies that this installation will be completed in accordance with the Alberta Safety Codes Act. A permit may expire if the undertaking to which it applies: (a) is not commenced within 90 days
of issue of the permit, (b) is suspended or abandoned for a period of 120 days. An extension can be considered when applied for in writing prior to permit expiry date.
**2 Sets of plans / specifications & payment must accompany this application**
Owner Name:
Mailing Address:
City:
Prov:
Postal Code:
Phone:
Fax:
Cell:
Email:
Owner's Signature / Declaration (Single Family Residential Only)
"I hereby declare I am the owner of the premises in which the work will be conducted, and reside or will reside on the property. I am doing the work myself, and assume responsibility
for compliance with the applicable Act and Regulations"
Company Name:
Mailing Address:
City:
Prov:
Postal Code:
Phone:
Fax:
Cell:
Email:
Contractor/Architect/Engineer Name
Signature
Project Location in the Town of Smoky Lake:
Work:
not started
in progress
complete
Street Address:
Tax Roll #:
Legal Subdivision: Part of:
Section:
Township:
Range:
West of:
Subdivision Name:
Lot:
Block:
Plan:
Directions:
BUILDING TYPE:
Dwelling Unit
Detached/Attached Garage
Accessory Building
Basement Development
Deck
Wood Burning Stove/Fireplace
Certification #
Foundation Type
Other (specify)
TYPE OF WORK:
New Construction
Relocation
Addition
Renovation
Demolition
Change of Occupancy
Manufactured Home*
Modular Home*
*CSA #
Development #
BUILDING USE:
Farm
Single/Multi Residential
Commercial
Industrial
Institutional
Oil & Gas
Other (specify)
BUILDING AREA IN SQ. FT.:
Number of stories
Main area
2nd floor
Basement
Garage
Total Area
Deck
Basement developed at time of construction?
Yes
No
Description of Work:
Energy Compliance Method:
Performance
Trade-Off
Prescriptive
*Manufactured Home - transportable in single or multiple sections; is ready for residential occupancy upon completion of setup.
*Modular Home - assembled at site in sections; sections have no chassis, running gear nor its own wheels.
Payment Type:
Cash
Cheque
Interac
M/C
Visa
Permit Fee: $
+ SCC Levy*: $
Total Cost: $
Receipt #:
*$4.50 or 4% of the permit fee maximum $560.00
The Inspections Group Inc.
300W, 14310 - 111 Avenue NW
EDMONTON AB T5M 3Z7
Phone:
(780) 454 5048
Toll Free: (866) 554 5048
Fax:
(780) 454 5222
Toll Free: (866) 454 5222
www.inspectionsgroup.com
[email protected]
REMIT PAYMENT AND APPLICATION TO THE INSPECTIONS GROUP INC.
PLEASE CONTACT THE INSPECTIONS GROUP INC. FOR INSPECTIONS ALLOWING 2 - 5 WORKING DAYS NOTICE AND PROVIDE SAFE ACCESS.
The personal information provided as part of this application is collected under the Safety Codes Act and the Municipal Government Act and in accordance with the Freedom of Information and Protection of Privacy
Act. The information is required and will be used for issuing permits, safety codes compliance verification and monitoring, and property assessment purposes. The name of the permit holder and the nature of the permit
is available to the public upon request. If you have any questions about the collection or use of the personal information provided, please contact the Municipality.