Plumbing & Gas

Commercial Building PermitProject Address

Permit Application

Property Owner

Postal Code

Name

Address

City

Phone

E-mail

Signature

PaidApplicant Contractor

Postal Code

Name

Address

City

Phone

E-mail

Signature

PaidApplicant

B/L #

AlterationNew

Type of Work

Inspection Services | 403-320-3920 | 910 4 Ave S, Lethbridge, AB T1J 0P6

Any personal information collected on this form is collected in accordance with Section 33(c) of the Freedom of Information and Protection of Privacy Act. Please Note that such information may be made public. If you have any questions about the collection, use, or disclosure of the personal information provided, please contact information Management at 910 4 Ave S, Lethbridge, AB, T1J 0P6 or by phone at 403-329-7329

Description of Work (Provide a description of the work being performed)

Date (YYYY/MM/DD)Applicant Name (Please Print)

I declare that I, or a quali�ed employee under proper supervision, will be performing the work applied for as stipulated in this permit application. As the property owner’s agent, I have veri�ed that the information contained within this application and all associated documents is correct and complete. I accept accountability for ensuring successful completion of all required City inspections at the appropriate stages of construction. I acknowledge that neither the granting of a permit, nor the approval of plans and speci�cations, nor inspections by a Safety Codes O�cer shall in anyway relieve the owner or the owner’s agent from full responsibility for carrying out the work in strict accordance with the Safety Codes Act and all relevant City Bylaws.

DECLARATION

Applicant Signature

Access Code

BuildingPermit #

DevelopmentPermit #

Total Construction Value

Permit Fee

Safety Code Fee

Total Permit Fee

Permit Fee Rate

Safety Code Levy Rate

Additional Fees

Construction Value × 0.008

Permit Fee × 0.04

Construction Values

Building

Heating

Fire Suppression

$

$

$

$

$

Professional

Postal Code

Name

Address

City

Phone

E-mail

Signature

PaidApplicant

Will you require a separate Footing & Foundation Permit?

Footing/FoundationPermit #

Electrical

Permit Fee Calculation

Permit Application

Inspection Services | 403-320-3920 | 910 4 Ave S, Lethbridge, AB T1J 0P6

RefundsIf a permit is canceled, refunds are based on the amount of e�ort that has been undertaken by the City of Lethbridge. If the refund is requested prior to the plans examination by a Safety Codes O�cer, the City of Lethbridge will retain $100.00 of the Permit Fee.

If the plans examination by a safety codes o�cer has begun on the permit, the City of Lethbridge will retain the greater of ½ of the Permit Fee or $100.00.

Commercial PermitsThe fee for any commercial permit shall be based on the estimated market value and calculated as $8.00 per $1000 market value (installation value) or part thereof. The minimum permit fee is $250.00

Permit Fee = Construction Value × 0.008

The Safety Codes Levy is collected by the City of Lethbridge on behalf of the Safety Code Council. It is calculated as 4% of the permits fees from a minimum of $4.50 to a maximum of $560.00

If any undertaking has been commenced by an applicant, owner or agent before a permit has been issued by a Safety Codes O�cer, the applicant may be required by a Safety Codes O�cer to pay a permit fee that is double the applicable fee.

Safety Code Levy = Permit Fee × 0.04

Additional Fees may be applied to the permit as required. For a full list of applicable fees, please see Section C of The Development Fees and Charges Bylaw (Bylaw 6108).

Total Permit Fee = Permit Fee + Safety Code Levy + Additional Fees

The Total Permit Fee is the sum of the Permit, Safety Code Levy, and any Additional Fees.

Installation ValueThe construction value is based on the total value of all the labour and materials required for this project. The City of Lethbridge will use an independent 3rd party estimation tool to verify installation values provided by the applicant.