250-390-6530
Building Inspection Services, Regional District of Nanaimo
6300 Hammond Bay Road, Nanaimo, BC V9T 6N2
Revised May 26, 2021
Page 1 of 2
Building Inspection
Archived Records Request
Applicant
Registered Owner of property
Agent (Authorization to Act as Representative section must be completed by the registered owners)
Building Inspection Information Requested; a copy of:
Plans (additional process time and charges) Occupancy Permit Site plan/survey
Septic field information/approval Building Permit Other (please specify):
Property Information
This section must be completed by the applicant. This information can be obtained from the property tax assessment notice or from the local
BC Assessment office. Your application cannot be processed without this information.
Authorization to Act as Representative
This section to be completed if the applicant is not a registered owner. If the applicant is not a registered owner and is not named below as havin
authorization to act as a representative, the information provided by the Regional District of Nanaimo (RDN) will be limited to
building permits issued for which records are available. The registered owner(s) hereby provides authorization for:
Name of representative (print)
To act as a representative for the registered owner(s) in the matter of the archived records for the property described above. I certify that I/We
am/are the registered owner(s) for the property described above.
If the registered owner is a firm or corporation, complete the following:
I am a member of the firm or corporation and I sign this on behalf of the firm or corporation
Name of firm or corporation (print)
Title of signing officer (print)
Declaration
I have read and understand the Archived Records Request procedures and terms found on the reverse of this application.
Personal information collected on this form is collected for the purposes of processing this building permit application and for administration and enforcement. The
personal information is collected under the authority of the Local Government Act, the Regional District’s Building Bylaw and pursuant to section 26 of the
Freedom of
Information and Protection of Privacy Act.