SBCG 23.1
Last updated 15/08/2018
Site Address:
Owner:
Phone:
Agent/Contact:
Phone:
COMPONENT/SYSTEM
Notes
DECLARATION
Signed by Owner or on behalf of the Owner:
Date:
For Council use only
Building Consent Number:
Reason for
acceptance / refusal:
Assessed and accepted / refused by:
Date:
Building Consent description updated by:
Date:
WAIVER OR MODIFICATION - APPLICATION FORM
(Section 67 Building Act 2004)
Relevant clause(s) NZ Building Code
Particulars of the waiver or modification (including why you believe it is reasonable for the Cou
ncil to grant the
waiver or modification)
If the waiver or modification involves construction details or notes on a plan, two sets of amended plans are
required that show changes
I declare as owner or agent of the owner, that I have provided all the information requested on this form, in
relation to the project and the site, known to the owner/ agent.
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Queenstown Lakes District Council
Southland District Council
Timaru District Council
Waimate District Council
Waitaki District Council
Central Otago District Council
Clutha District Council
Dunedin City Council
Gore District Council
Invercargill City Council
Mackenzie District Council
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signature
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