Facility Alteration Permit Application

Please read the guidelines prior for completing the form.

Requested by (name) *

Email address *

Applicant type *

RAA Tenant Company/Contractor

Pursuant to lease no.

At (facility) *

Location (civic address or area) of space to be altered *

Details of work *

Work location *

Map location

Double click on the map to select a location. Double click a marker to remove it.

Is this work for any of the following? *

New construction / amendment Renovation Addition Other

Does this work require excavation or dig? *

Yes No

Does this work require a crane? *

Yes No

Has this document been designed and stamped by a professional registered to practice in the province of Saskatchewan? *

Yes No

Please specify if you will be connecting to any of the following RAA-owned utilities or building systems: *

Please specify if your work will involve any of the following activities:

Handling of hazardous material products
Storage of hazardous material products
Storage of waste, this include but not limited to both construction and organic materials (e.g. topsoil, clay, etc.)

Estimated cost *

Estimated time to complete *

Starting date *

Proposed work starting date should be a minimum of 15 business days from the date of this application submission.

Completion date *

Name and address of Contractor *

Name and address of Engineer or Architect *

Engineer or Architect phone number *

Send correspondence to (name and address of employee in charge of work) *

Employee phone number *

Applicant’s name (as it appears on lease or license) *

I hereby confirm my comprehension and acceptance of all the terms and conditions delineated above. I commit to adhere to these provisions conscientiously. In the event of non-compliance, it is understood that operational cessation may occur, and RAA shall not be deemed liable for said outcome.

Applicant or Proponent signature *

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Please attach any documents, plan drawing, or photos