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PROPERTY STANDARDS BY-LAW
NOTICE OF APPEAL
The Notice of Appeal Form must be received on or before 5:00 p.m. on the final date for appeal, with a copy of the
Order and non-refundable administration fee. Send by registered mail or deliver to: City of Kitchener, Legislated
Services, Attention: Property Standards Appeal Committee Secretary, 200 King St. W., Kitchener, ON N2G 4G7.
Appeals received after the date of appeal listed on the Order to Comply will not be processed, not heard by the
Committee and the fee will be returned to the Appellant.
APPELLANT INFORMATION
Name of Appellant:
Street Address:
City or Town: Province: Postal Code:
Phone Number: Email Address:
ORDER TO COMPLY APPEAL INFORMATION
Property Address:
Order No. (e.g. 17 123456 PI): Issue Date:
Property Owner/Occupant:
Agent (If any):
(If any, please fill out the Authorization to Act as an Agent for Appeal form attached)
A copy of the Order to Comply is
Appeal Deadline on Order: attached to this Notice of Appeal, as
required.
BRIEFLY EXPLAIN THE REASON(S) FOR YOUR APPEAL
I am requesting an extension of time to comply with the Order I disagree with the order
(modify or quash the Order)
I am submitting additional documentation (e.g. photos, written documents) attached to
this Notice of Appeal.
Signature:__________________________________ Date: ___________________________
Property Owner/Occupier or Agent
OFFICE USE ONLY
Date Notice of Appeal received: Notice of Appeal received by:
Accepted Incomplete Refused
Reason for refusal:
Date of Hearing: Notice of Appeal forwarded to: By-Law Legal
Notice: Please note a public agenda will be posted indicating the residential address listed on the Order to Comply.
The personal information in relation to this form is collected under the authority s. 28(2) of Municipal Freedom of
Information and Protection of Privacy Act (MFIPPA) and will be used by the City of Kitchener to process appeals. If
you have any questions regarding this collection of personal information, you can contact Jaclyn Rodrigues at
telephone number 519-741-2200 or email address jaclyn.rodrigues@kitchener.ca.
PROPERTY STANDARDS BY-LAW
AUTHORIZATION TO ACT AS AN AGENT FOR APPEAL
Only authorized agents by signature of the property owner/occupant prior to the Hearing may address the City of
Kitchener Property Standards AppealCommittee on behalf of the subject property.Send by mail or deliver to: City
of Kitchener, Legislated Services, Attention: Property Standards Appeal Committee Secretary, 200 King St. W.,
Kitchener, ON N2G 4G7.
IF THE PROPERTY OWNER/OCCUPANT IS AN INDIVIDUAL
I/We, _________________________________ \[insert name(s) of owner(s)/occupant(s)\], the
owner(s)/occupant(s) of ____________________________________ \[insert address of
property\] authorize _______________________________ \[insert name of agent\] to act as
my/our agent for the purposes of the appeal of Order ________________________________
\[insert Order number\], dated ___________________________ \[insert issue date\] to the City
of Kitchener Property Standards Appeal Committee.
Agent Mailing Address:
Street: _______________________________________
City or Town: ______________________ Postal Code: ________________________
Agent Phone Number: _______________ Agent Email: _________________________
Signature: _________________________ Date:_____________________
Signature: _________________________ Date: ____________________
IF THE PROPERTY OWNER/OCCUPANT IS A CORPORATION
On behalf of, _________________________________ \[insert name of the corporation\],
which owns/occupies ____________________________________ \[insert address of
property\], I, _______________________________ \[insert name of person authorized to
bind the corporation\], authorize ______________________________ \[insert name of agent\]
of Order ____________ \[insert
Order number\], dated ___________________________ \[insert issue date\] to the City of
Kitchener Property Standards Appeal Committee.
Corporation Name: ΗΗΗΗΗΗΗΗΗΗΗΗΗΗΗΗΗΗΗΗΗΗΗΗΗΗΗΗΗΗΗΗΗΗΗΗΗΗΗΗΗΗΗΗΗΗΗΗΗΗΗΗΗΗΗΗΗΗΗΗ
Corporation Mailing Address:
Street: _______________________________________
City or Town: ______________________ Postal Code: ________________________
Agent Phone Number: _______________ Agent Email: _________________________
Signature: _________________________ Date:_____________________
Position: _________________________
I have authority to bind the corporation.
The personal information in relation to this form is collected under the authority s. 28(2) of Municipal Freedom of Information and Protection of
Privacy Act (MFIPPA) and will be used by the City of Kitchener to process appeals. If you have any questions regarding this collection of
personal information, you can contact Jaclyn Rodrigues at telephone number 519-741-2200 or email address jaclyn.rodrigues@kitchener.ca.