Application for Project Information Memorandum and/or Building For Official use Project Number: Consent (Form 2) Section 33 or section 45, Building Act 2004 Date Received: * Items marked are mandatory for all applications. Complete this form in BLOCK CAPITALS using BLACK or BLUE ink. 1. Type of Application I request that you issue a*: Project Information Memorandum (PIM) only (Tick one box only) for the building work Building Consent only OR Amendment to Building Consent: described in this application Building Consent including PIM 2. The Building Valuation Roll Number: Street Address*: Description*: Lot: DP: Building Name (if applicable): Number of Levels: Number: Number of Occupants*: Floor Area* (all floors Existing: Additional: incl.): m2 m2 Current lawfully authorised use: Approx year building first constructed: (refer NZBC A1 Use) (if an addition or alteration) “Classified 3. The Owner [include preferred form of address, eg, Mr, Miss, Dr, if an individual] Owner’s Name*: Contact Person: (if owner is a company) Mailing/ Street Address/ Billing Address*: Registered Office: Phone Number: Cell Phone: Fax: e-mail: website: 4. The Agent (if applicable) The Agent will be the first point of contact for communications with the Council / Building Consent Authority regarding this application / building work and will receive all correspondence including all invoices. Agent’s Name: Contact Person: (if is a company) Mailing/ Street Address/ Billing Address: Registered Office: Telephone Number: Cell Phone: Fax: e-mail: website:
Application for Project Information Memorandum and/or Building Consent (Form 2) Section 33 or section 45, Building Act 2004 For Official use Project Number: Date Received: Items marked * are mandatory for all applications. Complete this form in BLOCK CAPITALS using BLACK or BLUE ink. 1. Type of Application I request that you issue a*: (Tick one box only) for the building work described in this application Project Information Memorandum (PIM) only Building Consent only OR Amendment to Building Consent: Building Consent including PIM 2. The Building Valuation Roll Number: Street Address*: Description*: Lot: DP: Building Name (if applicable): Number of Levels: Number: Number of Occupants*: Floor Area* (all floors incl.): Existing: m2 Additional: m2 Current lawfully authorised use: (refer NZBC A1 “Classified Use) Approx year building first constructed: (if an addition or alteration) 3. The Owner [include preferred form of address, eg, Mr, Miss, Dr, if an individual] Owner’s Name*: Contact Person: (if owner is a company) Mailing/ Street Address/ Billing Address*: Registered Office: Phone Number: Cell Phone: Fax: e-mail: website: 4. The Agent (if applicable) The Agent will be the first point of contact for communications with the Council / Building Consent Authority regarding this application / building work and will receive all correspondence including all invoices. Agent’s Name: Contact Person: (if is a company) Mailing/ Street Address/ Billing Address: Registered Office: Telephone Number: Cell Phone: Fax: e-mail: website:
MT_Form%202%20Application%20for%20PIM-BC_V4_20180723.docx