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Demolition Permit

Personal information on this demolition permit is collected under the authority of the Health Protection and Promotion Act and will be used for the administration of Public Health programs. Any questions about the collection of this information should be directed to the manager of Environmental Health, KFL&A Public Health, 221 Portsmouth Avenue, Kingston, Ontario, K7M 1V5, 613-549-1232 or 1-800-7875, ext. 1243.

This demolition permit is in connection with my application to the building inspector for a permit to demolish a building.

Address of building to be demolished

Ward or Township (e.g., Napanee, Kingston, North Frontenac etc.)

I hereby request certification that there was no evidence of rodents or vermin at the time of inspection.

Owner or authorized agent name

Phone number (999-999-9999)

E-mail address (to receive your submission receipt)

By checking this box, I acknowledge I have read, understand, and agree that the information provided in this form is correct.

Yes