Advice of Licensed Building Practitioners

*- indicates required field.

The Building

Building street address: *

Building name: (optional)

(if applicable)

The Project

Building consent number: *

(e.g. BC180001)

The Owner

(must be completed and all details must be the owner's)

Owners name: *

(for individuals, state the preferred form of title, e.g. Mr, Mrs, Ms, Miss, Dr. For companies, trusts and other organisations provide a contact person’s name)

Address: *

Can't find your address? Enter it manually

Landline: (optional)

Area Number

Mobile: *

After hours: (optional)

Area Number

Fax: (optional)

Area Number

Email: *

Licensed Building Practitioners Engaged to Carry Out/Supervise Restricted Building Work

Particular work to be carried out or supervised: *

Name, address, email and phone number of Licensed Building Practitioner

Name: *

Address: *

Can't find your address? Enter it manually

Email: *

Telephone: *

Licensed Building Practitioner number: *

(or registration number if treated as being licensed under section 291 of Act)

Licensing class: *

Foundations

Carpenter

Bricklayer

Plasterer

Roofer

Relationship to building consent: *

Owner

Agent on behalf of owner (with the authority of the owner)

Name of person completing this form: *

Date: *