1
2Development
and / or
PLANNING AND DEVELOPMENT SERVICES
Mailing Address:
Building
th
453 West 12
Avenue, Vancouver BC V5Y 1V4
Application Form
tel: 604.873.7611
To help expedite submission of your application, please fill out BOTH sides of this information sheet prior to attending the Application Preview counter
located in the Development and Building Services Centre, Ground Floor, 515 West 10th Avenue (West Annex, City Hall).
JOB LOCATION
(Correct and complete addressing is important. Complete this section carefully.)
Address:
Specifics:
Floor Level:
Suite No:
Legal Description:
Lot(s)
Block(s)
District Lot(s)
Plan Number(s)
Are you aware of the presence of any contaminated soils on the subject property?
Yes
No
Are you aware of the existence of any contaminated soils studies, reports, soil agreements, or Ministry of Environment
orders or letters with respect to the subject property?
Yes
No
Is the building being converted to strata-title ownership?
Yes
No
Note: If you intend to convert an existing building to strata title ownership, please contact Subdivision and Strata Title
staff at 604.871.6627 for information on the strata conversion process in advance of the issuance of any permits.
This area must be completed by the person signing the application form
Your Name:
You are the:
01
Property Owner
Mailing Address:
02
Contractor
03
Certified Professional
City:
Postal Code:
04
Design Professional
05
Tenant
E-mail Address:
06
Agent for Owner
07
Agent for Tenant
Phone Number:
Fax Number:
08
Consultant
09
Non-profit Association
Company Name:
Cert. No:
10
Civic Department
Account
Business License
Number:
98
Other
Note: Contractors/design professionals/consultants MUST have a valid Business License to do work in the City of
Vancouver. You may obtain current business license account numbers from the Business License Counter.
Complete the following for ALL applications
Property Owner’s Name:
Address:
City:
Postal Code:
Phone Number:
No
Is the owner aware of this application?
Yes
Contractor’s Name:
Address:
City:
Phone Number:
Postal Code:
Business License Account Number:
Tenant’s Name:
City:
Address:
Postal Code:
Phone Number:
Job Contact:
City:
Address:
Postal Code:
Phone Number:
Qualified Professional Contact Name
(required for Salvage & Abatement):
City:
Postal Code:
Address:
Phone Number:
Business License Account Number:
Please continue application on reverse
Development
and / or
PLANNING AND DEVELOPMENT SERVICES
Mailing Address:
Building
th
453 West 12
Avenue, Vancouver BC V5Y 1V4
Application Form
tel: 604.873.7611
To help expedite submission of your application, please fill out BOTH sides of this information sheet prior to attending the Application Preview counter
located in the Development and Building Services Centre, Ground Floor, 515 West 10th Avenue (West Annex, City Hall).
JOB LOCATION
(Correct and complete addressing is important. Complete this section carefully.)
Address:
Specifics:
Floor Level:
Suite No:
Legal Description:
Lot(s)
Block(s)
District Lot(s)
Plan Number(s)
Are you aware of the presence of any contaminated soils on the subject property?
Yes
No
Are you aware of the existence of any contaminated soils studies, reports, soil agreements, or Ministry of Environment
orders or letters with respect to the subject property?
Yes
No
Is the building being converted to strata-title ownership?
Yes
No
Note: If you intend to convert an existing building to strata title ownership, please contact Subdivision and Strata Title
staff at 604.871.6627 for information on the strata conversion process in advance of the issuance of any permits.
This area must be completed by the person signing the application form
Your Name:
You are the:
01
Property Owner
Mailing Address:
02
Contractor
03
Certified Professional
City:
Postal Code:
04
Design Professional
05
Tenant
E-mail Address:
06
Agent for Owner
07
Agent for Tenant
Phone Number:
Fax Number:
08
Consultant
09
Non-profit Association
Company Name:
Cert. No:
10
Civic Department
Account
Business License
Number:
98
Other
Note: Contractors/design professionals/consultants MUST have a valid Business License to do work in the City of
Vancouver. You may obtain current business license account numbers from the Business License Counter.
Complete the following for ALL applications
Property Owner’s Name:
Address:
City:
Postal Code:
Phone Number:
No
Is the owner aware of this application?
Yes
Contractor’s Name:
Address:
City:
Phone Number:
Postal Code:
Business License Account Number:
Tenant’s Name:
City:
Address:
Postal Code:
Phone Number:
Job Contact:
City:
Address:
Postal Code:
Phone Number:
Qualified Professional Contact Name
(required for Salvage & Abatement):
City:
Postal Code:
Address:
Phone Number:
Business License Account Number:
Please continue application on reverse
City of Vancouver Development and/or Building Permit Form continued
This application is to: (Check applicable boxes)
Is this a new tenant?
Yes
No
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.
BU
Special Sprinkler Inspection Number SP
DE
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
DE
SUBTOTAL __________________________________________
Building Permit/Application Number
BU
SP ________________________________________________
Board of Variance Appeal Number
Z
TOTAL _____________________________________________
Combined Permit Application Number
DB
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
20
SIGNATURE OF APPLICANT
DOC/2016/081493 (Revised March 2016)
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