Waimakariri District Council
170524052747 [v01]
V1 -
1/01/2018
2 of 2 Application for a Waiver or Modication to a Specic Clause in the Building Code
PART 2 - DETAILS
1 7. Description of waiver or modication:
Identify the specic clause of the building code to which this application for a waiver or modication has been requested
State the reasons as to why a waiver or modication has been requested and why compliance with the building code
cannot be achieved:
OWNER / AGENT AUTHORISATION
PLEASE NOTE - By entering your name in the box below you are giving your authority for the application to proceed.
Name:
Date:
I am the
Owner
Agent
Note: If acting on behalf, by entering your name above you hereby declare that you are authorised to act as Agent for
the Owner.
NB: Ensure Agent Authorisation section is completed - see below.
AGENT AUTHORISATION
(TO BE AUTHORISED BY OWNER)
PLEASE NOTE - By entering your name in the box below you are giving your authority for this application to proceed.
I authorise
to act as Agent on my behalf for this
Building Consent application under Sections 33 and 45 of the Building Act 2004.
With respect to this Building Consent application, I authorise
to act
as Agent on my behalf for the application for Code Compliance Certicate under Section 92 of the Building Act 2004.
Name (Owner): Date:
PRIVACY INFORMATION
The information you have provided on this form is required so that your building consent application can be processed under the
Building Act 2004. The Council collates statistics relating to issued building consents and has a statutory obligation to forward
these regularly to Statistics New Zealand. The Council stores the information on a public register, which must be supplied (as
previously determined by the Ombudsman) to whoever requests the information. Under the Privacy Act 1993 you have the right
to see and correct personal information the Council holds about you.