Application for a Permit Under Town of Mount Royal Regulation No.1480 on the Sale and Use of Pesticides

General Information About the Applicant

Last name of applicant

Name of applicant

Headquarters phone number

License number (from MELCCFP)

Mailing address of the corporate headquarters

MELCCFP (Ministry of the Environment, Climate Change, Wildlife, and Parks) permit category

C3 — Application on uncultivated land

C4 — Application in ornamental horticulture

C5 — Application for pest control

C6 — Application by fumigation

C10 — Use in buildings for horticultural purposes

C11 — Other cases of application

Please specify

Representative of the applicant

Representative's full name

Representative's mailing address

Representative's phone number

Representative's email address

Pesticide applicator employed by the applicant’s company

Please submit information regarding all pesticide applicators employed by your organization who hold a certificate of competence issued by the MELCCFP under the Pesticides Act (please complete Appendix A).

Appendix A (in french only)

Please submit Appendix A.

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Areas of Focus

Agricultural

Food related

Transport and energy corridors

Extermination

Horticulture

Industrial

Institutional

Residential

Other

Please speciy

Required documents to include with your permit application

A copy of the pesticide purchase and use permit issued to your company by the MELCCFP.

A copy of the MELCCFP certificates for all pesticide applicators employed by your company, as listed in Appendix A.

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Please explain why you are unable to submit the required documents. The City reserves the right to suspend the issuance of a permit if the applicant’s application is incomplete.

Declaration by the applicant

That the information provided is true and accurate.

That he has read and agrees to comply with the terms of the Town of Mount Royal’s Regulation on the Sale and Use of Pesticides;

The pesticide applicator is solely responsible for the use of pesticides and must use them prudently and diligently in the course of their activities. The Town’s authorization, in the form of an annual permit, does not exempt the applicator from their health and safety obligations.

Applicant's signature

Date

Submitting the permit application form

I am submitting the completed form along with all required documents to the following email address: travauxpublics@ville.mont-royal.qc.ca.

The permit fee is $215, payable at the counter of the Urban Planning Department, at 20 Roosevelt, Mount Royal.

By signing this application, the applicant agrees to submit the completed form along with all required documents to the email address: travauxpublics@ville.mont-royal.qc.ca

Please allow 30 business days between the receipt and processing of your application.

If your application is approved, the applicant agrees to obtain and pay for the permit at the Urban Planning Department located at 20 Roosevelt Avenue, H3R 1Z4; Tel: 514 734-3042.

It is valid for the current year and expires on December 31 of the calendar year. For permits for the year 2027 and beyond, an application must be submitted before October 1 of the preceding year, and the pesticide application log for the Town of Mount Royal must have been submitted.

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Application for a Permit Under Town of Mount Royal Regulation No.1480 on the Sale and Use of Pesticides