City Of Vancouver Development And Building Application Form Page 2

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City of Vancouver Development and/or Building Permit Form continued

This application is to: (Check applicable boxes)

Is this a new tenant?

Yes

001

Construct a new building(s)

002

Add to an existing building

What is the existing use?

003

Alter the interior/exterior

What is the proposed use?

004

Add to a building and alter the existing portion

005

Add to a building and change the use

How many storeys?

006

Add to the building, alter existing portion and change

use

How many levels of underground parking?

007

Interior/exterior alterations and change of use

008

Enclose an area of an existing building (balcony

How many new rooftop units?

enclosures)

011

Project/Site Permit

Describe work to be done:

014

Change of use

(Complete carefully, Your application will be based on your

015

Retain use

written description.)

016

Alter grade (raise or lower grade)

022

Alterations to legalize a suite

023

Alterations for a new suite

026

Demolish

Commercial

Fire damaged building

Non-rental one-family dwelling

Heritage building

Residential rental building

028

Temporary tents

030

Construct a garage/carport

031

Add/alter/demo garage/carport

038

Construct partial - framing, etc.

040

Excavate - valid for project address et al.

041

Move building from another site

042

Move building on the same site

043

Install a pool, fence, tennis court, boat ramp, sign, or

similar

044

Upgrade seismic and/or sprinkler

045

Mechanical kitchen exhaust, roof top unit, satellite dish

046

Prefabricated structure placed on site

047

Fire damage repair

048

Flood damage repair

050

Landscape only

053

Building envelope repair

Office Use Only

What is the value of the work proposed? (Include cost of

plans, material and labour)

Will any of the following be altered/repaired/installed?

Select all that apply:

Electrical

Gas

Drain Tile

Plumbing

Sprinkler

Fire Alarm

Sprinkler Contractor’s Name:

Note: If the sprinkler contractor noted on this application

changes, please notify the City of Vancouver in writing

Office Use Only

Invoice #

within 24 hours.

Special Sprinkler Inspection Number SP

Complete the following for all residential buildings

Existing

Proposed

Office Use Only

Total number of dwelling units:

BU ( WWOP? ) _______________________________________

Total number of housekeeping units:

DE ________________________________________________

Total number of sleeping units:

DT ________________________________________________

Complete the following related permit information

BG ____________________ f/m _______________________

Development Permit/Application Number DE

ENV. PROT. Site Profile ______________________________

Minor Amendment Number

SUBTOTAL __________________________________________

Building Permit/Application Number

SP ________________________________________________

Board of Variance Appeal Number

TOTAL _____________________________________________

Combined Permit Application Number

As owner or owner’s agent, I have verified that the information contained within this document and associated applications and plans is correct, and

describes a use, a building or a work which complies with all relevant by-laws and statutes. I understand that personal information contained in this form

will not be released to the public except as required by law; however, all associated applications and plans will be made publicly available during the

development or building application process. I acknowledge that responsibility for by-law compliance rests with the owner and the owner’s employees,

agents and contractors. I will indemnify and save harmless the City of Vancouver, its officials, employees and agents against all claims, liabilities and

expenses of every kind, in respect to anything done or not done pursuant to this application or fact sheet or ensuing permit, including negligence and/or

the failure to observe all by-laws, acts or regulations.

SIGNED AT VANCOUVER, B.C. THIS

DAY OF

SIGNATURE OF APPLICANT

DOC/2016/081493 (Revised March 2016)