Form B70-1038 Page 4 of 4 REV 2/14
Applicable code reference(s): ___________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Give specific reasons for the request:____________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
VERIFICATION
I verify that the statements contained in this application are true. I understand that if this application contains
a false statement, I can be prosecuted under BC 5.08.600 and, if convicted, I could be subject to a fine of up
to $1,000.00 or imprisonment of up to six months, or both. Note: All parties who are named as appellants
must sign this notice of appeal.
_________________________________________ ____________________
Signature Date
The Construction Board of Appeals meets the first Tuesday of each month. All appeals must be filed a
minimum of 15 days prior to the meeting date. Appellant has the right to be notified by mail at least ten days
before the hearing, of the date, time and place for the hearing, unless the right to the notice is waived.
* * * * * * * * *
Appellant may waive the ten-day written notice by signing the following waiver.
I understand that I have the right to ten days written notice of the date, time and place for the hearing. I
choose to waive the ten-day-written notice of Construction Appeals hearing date, time and place.
__________________________________________ _____________________________________
Signature Date