Application to Construct, Extend or Alter a Public Building

Application to Construct, Extend or Alter a Public Building

Health Act 1911 Health (Public Buildings) Regulations 1992 (Reg. 4)
Team Name
I, being the owner/agent, hereby apply under Section 176 of the Health act to construct alter or extend a public building
Premises Details
Premise Name:*
Premise Address*

Location No

Street

SuburbState

Post Code
Nearest Cross Street
Intention for Use*
Any of the following may sign this notice:

The owner, occupier, manager, trustee or other person by whose authority such as public building is intended to be built created or converted thereto.
Owner/Agent Name*
Address*

Street Address

Street Address Line 2

SuburbState

Post Code
Phone Number (mobile)*
Please enter a valid phone number.
Alternative Phone Number
Please enter a valid phone number.
Email*
example@example.com
In support of this application, i hereby submit the following:*

Detailed plans showing proposed layout/alterationsPrescribed application fee (upon submitting your application, the City will contact you to arrange payment of the application fee).
For current application fees, refer to the Health Services Schedule of Fees and Charges.
File Upload

Cancelof
Signed*

Clear
Date*

DayMonthYear
Date
Upon submitting your application, the City will contact you to arrange payment of the application fee.

If you require further information, please contact the City's Health Services on 9394 5000 or via email at info@armadale.wa.gov.au.
Should be Empty:

Any of the following may sign this notice: