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Project Address

Description of work*

Agent/Architect Name & Address

Agent Tel No

Agent Email address

Note: Please make sure it's correctly entered!

Client Name & Address

Client Tel No

Client Email address

Invoice Recipient & Address

For Attention of

Purchase Order No

Recipient Telephone No

Recipient Email address

Copies of Plans

Plans To Follow by post
Plans To Follow by Email

(Please enclose location plan if work involves
an extension or new building.
If new build please, also indicate approximate
positions of proposed connections to sewers
or other drainage outfall)

The Building is/is not constructed over or within 3m of a sewer

Yes, it is
No, It is not

Please select the appropriate option

Agreed Fee £

Or, Approx contract
cost £

Contractor Name

If known

Contractor Tel

Contract Start and Hand Over Dates

If known

I agree to your terms of business and confirm on behalf of the client that I would like you to act in your capacity of Approved Inspectors. Please sign and submit the Initial Notice to the Local Authority on their behalf.

Your Name

Company

Date

*Note: Please enter today's date

On behalf of (Clients Name)

* Please provide full details to enable accurate quotation

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