Civic Address (Street No. & Name):

Building Permit District of Squamish 37955 2nd Avenue, PO Box 310 Squamish, BC V8B 0A3 604.815.5011 www.squamish.ca Application Form Civic Address (Street No. & Name): OFFICE USE ONLY: Folio/Roll No.: Application Processing Fee Receipt #: BP Fee(s) Receipt #: Applicant Notified that Permit Ready: DD / MM / YYYY Is the proposed project on a serviced lot? Yes No Is the Applicant/Owner in good standing with the District of Squamish? Yes No BUILDING VALUE*: $ *Calculated per Building Bylaw 1822, 2004 IMPORTANT: BUILDING PERMIT NO.: Application Date: [stamp above in document header] Scan to BPA Review Group (Eng., Fire, Bus. Licence) Complete (initial): Engineering: Environment: Fire Dept.: Development Services Representative (initial): Building Permits are only issued to projects where a General Contractor is registered with the Homeowner Protection Office (HPO) as a Licensed Builder, or an Owner Builder has received a Letter of Exemption from HPO. Before you submit your application, you must ensure you have the appropriate (if any) Land Development Permit(s) and Service Agreements for your property. Contact the Development Services Department to confirm. APPLICATIONS ARE NOT ACCEPTED UNLESS COMPLETE, WITH THE REQUIRED FEE & DOCUMENTS. OWNER DETAILS: Full Name: Company Name: Mailing Address Street No. & Name: City: Province: Postal Code: Bus. Ph: Home Ph: Email (required): GENERAL CONTRACTOR DETAILS (if different to Owner Builder): Full Name: Business Name: Bus. Licence #: Mailing Address Street No. & Name: City: Province: Postal Code: Bus. Ph: Home Ph: Email (required): APPLICANT DETAILS (if different to Owner and/or General Contractor): Full Name: Business Name: Bus. Licence #: Mailing Address Street No. & Name: City: Province: Postal Code: Bus. Ph: Home Ph: Email (required): Copyright 2013 District of Squamish www.squamish.ca Last Updated: 9 August 2013 Page 1 of 6

PAYEE DETAILS: Send payment correspondence, receipts, and (if applicable) refunded deposits to (check one): Owner Applicant APPLICATION TYPE: NOTE: If you are planning to construct a Single Unit Dwelling with an Accessory Building, you must submit two Building Permit Application Forms, one for each building type. Building Type (check one box only): Single Unit Dwelling Accessory Building Commercial Single Unit Dwelling with Suite Carriage House Industrial Two Unit Dwelling (Duplex) Modular/Mobile Home Institutional Multi-Unit Dwelling Floating Building/Structure Construction Type (check all relevant boxes): New Construction Water/Sanitary/Storm Service (Off-site) Change of Occupancy Addition Plumbing Alterations Suite Installation Alteration Leasehold (Tenant) Improvements Relocation of a Building Deck Swimming Pool Demolition PROPERTY INFORMATION: Legal Description (on Land Title Certificate): Block No.: Plan No.: Parcel Identifier (PID): _ - _ - _ Land District / Township (TWP): Section No.: Lot No.: Lot Description: Has a Land Development Permit been issued for this application: No Yes, LD Permit # If applying for a Two Unit (Duplex) or Multi-Unit Building Permit, will the property be strata titled? Yes No PLEASE READ CAREFULLY AND ANSWER ALL QUESTIONS: Yes No N/A 1. Is the Owner aware of this application? 2. Is there a Board of Variance appeal involved? 3. Is there any damage to your lot frontage or District property? 4. Does the site have an existing driveway from a street? a. If yes, will this driveway be used for the new development or demolition? 5. Are you proposing a new driveway from the street? 6. Is this lot registered in Land Titles? 7. Is there an existing secondary suite in the principal building? 8. Is this application being submitted as requested by a Building Official in order to legalize an existing secondary suite? 9. Will there be any alterations to existing fire separations? Copyright 2013 District of Squamish www.squamish.ca Last Updated: 9 August 2013 Page 2 of 6

RIPARIAN AREAS: Please indicate if your project applies to the following: Watercourses, ditches, wetlands, or seasonal drainage pathways present on site or located within 30m of property* * Refer to the Official Community Plan, Development Permit Area 11 for the Riparian Area Guidelines. NATURAL ENVIRONMENT AREAS: Please indicate if your project is known to be in one of the following areas*: Squamish Estuary Conservation Area Brackendale Eagle Reserve Baynes Island Ecological Reserve Mamquam Blind Channel (upper reaches) * Refer to the Official Community Plan, Development Permit Area 1, Schedule C for the Natural Environment Area Guidelines. LIST OF PROFESSIONALS: Please complete the following information for each professional on your project. Each professional must have a valid Business Licence (BL) for the District of Squamish (provide each BL number below). Professional Company Contact Name Address Phone/Cell Coordinating Registered Professional (CRP)* Architect Fire Suppression Engineer Geotechnical Engineer Structural Engineer BCLS Land Surveyor Electrical Plumbing * CRP only required for complex buildings and when there are four or more registered professionals on the project. OFFICE ONLY Licence Check PROJECT DESCRIPTION: Describe in detail the nature of your project: Copyright 2013 District of Squamish www.squamish.ca Last Updated: 9 August 2013 Page 3 of 6

BUILDING SPECIFICATIONS: You must complete the following sections providing as much information as possible; information is available from various sources including www.squamish.ca, the Official Community Plan, the Zoning Bylaw, and on your building plans. SITE & SERVICE INFORMATION: Do you have a Service Agreement with the District of Squamish? Yes No If No, have you confirmed service locations for this property (water, sanitary, storm, dike)? Yes No If your property is adjoined to another building(s), what is the use of the other building(s)? ZONING INFORMATION (not required for plumbing-only alterations): Zoning for your Property: (e.g. RS1) Is there a Development Variance? Yes No To confirm your property zone, go to www.squamish.ca and use the Parcel & Land Use Map. To confirm the heights and setbacks for your zone, refer to the Zoning Bylaw. SPECIFICATION BYLAW REQUIREMENT OR VARIANCE PROPOSED Gross Floor Area (m 2 ): Floor Area Ratio (comparison of the floor area to the size of your lot) (%): Front Yard Setback (m/ft): Rear Yard Setback (m/ft): Side Yard Setback (interior) (m/ft): Side Yard Setback (exterior) (m/ft): Existing Average Grade (provide calculations; refer to Site Plan): Building Height (m/ft) (as per Zoning Bylaw, Section 1 Interpretation): Building Face Front (m/ft) (as per Zoning Bylaw, Section 1 Interpretation): Right Side Setback (m/ft): Left Side Setback (m/ft): Other Side Yard, if applicable (m/ft): Lot Area (m 2 /ft 2 ): Lot Coverage (%): Frontage (m/ft): No. Parking Spaces: Copyright 2013 District of Squamish www.squamish.ca Last Updated: 9 August 2013 Page 4 of 6

STRUCTURE INFORMATION (if applicable; check all relevant to your project): No. Dwelling Units: Accessory Suite? Yes No Floor Area of Unit #1 (m 2 /ft 2 ): Floor Area of Unit #2 (m 2 /ft 2 ): Flood Construction Level (FCL) (m): Steep Slope (equal to or >30 degrees): Yes No Storeys: 1 1 ½ 2 More: Construction: Block Frame Foundation Footings: Engineered Concrete _ Foundation Walls: Engineered Concrete Exterior Walls: 2 x 4 2 X 6 Exterior Wall Finish: Vinyl Stucco Hardy Plank Brick _ Upper Floor: N/A 2 X 10 16 oc 2 X 10 12 oc TJI Other: Main Floor: 2 X 10 16 oc 2 X 10 12 oc TJI Lower Floor: N/A Crawl Space On Grade _ Interior Walls: 2 X 4 2 X 6 Roof Structure: Truss Hand Frame Roof Finish: Duroid /Composite Tile Shake Metal _ Method of Heating/ Ventilation: Baseboard Forced Air Heat Pump HRV Fireplace: Gas Wood Electric Other: Type of Chimney: Class 1 Masonry/Stone _ Driveway Surface: Concrete Permeable material Asphalt Culvert Required: Yes No Exterior Guardrails (deck): Wood Glass Aluminum _ PLUMBING PERMIT INFORMATION (if applicable): 1. Total number of Washrooms (Commercial/Tenant (Leasehold) Improvements only): 2. Total number of Accessible Washrooms (Commercial/Tenant (Leasehold) Improvements only): 3. Enter the number of plumbing fixtures in your project next to each of the relevant items below: Water Closets/Toilets: Clothes Washers: Kitchen Sinks Floor Drains: Bathtubs (with or without shower head): Showers: Hot Water Tanks Drink Fountains: Dishwashers: Laundry Sinks: Interceptors: Hose Bibs: Irrigation: Bathroom Sinks: Sprinkler Heads: Total Fixtures: Other (describe fixture(s) & include quantities): TOTAL Hydraulic Load (current BCBC): fixture units 4. Sump required for services (sanitary, storm)? If Yes, include location and design of sump indicated on Detailed Design Drawings (DDDs). Yes No N/A Copyright 2013 District of Squamish www.squamish.ca Last Updated: 9 August 2013 Page 5 of 6

OFFICE USE ONLY: OCCUPANCY Use No. of Suites Total Floor Area Building Code Occupancy Classification Major: Minor: IMPORTANT: Applicant must pay their Application Fee (also referred to as Plan Processing Fee ) of $75.00 at the time of submission. All contractors must have a valid District of Squamish Business Licence. Changes to plans for a Building Permit Application that is already being processed must be approved by a Building Official prior to permit issuance; new drawings may be required. As owner and/or owner s agent, I have verified that the information contained in this form and associated plans is correct, and describes the use, building or work which complies with all relevant bylaws and statues. I/we have attached to this application the documents required as noted in the Building Permit Document Checklist, along with the required fee(s), and hereby agree to submit further information deemed necessary for processing this application. I acknowledge that the responsibility for bylaw and Building Code compliance rests with the owner and the owner s employees, agents and contractors. I will indemnify and save harmless the District of Squamish, 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 ensuing permit, including negligence and/or the failure to observe all bylaws, Building Code, Acts or Regulations. By signing below, I/we acknowledge I/we have read and understand the District Squamish Zoning Bylaw, Building Bylaw, Subdivision and Development Control Bylaw, and Watercourse Bylaw, including: No excavation, construction, enlargement, alteration, repair, removal or demolition of any building or structure, or part thereof, shall be commenced or undertaken without a permit being first obtained from the District of Squamish. Thou shall not occupy a building or premise until a Building Official at the District of Squamish grants occupancy. Every owner to whom a permit is issued shall be responsible for the cost of repair to any damaged District property. No permit for construction of any residential, commercial or industrial building shall be issued unless the following essential services are provided: road, water, sewer, and storm drainage. This project will be constructed in conjunction with the Wildlife Attractant Bylaw 2053, 2009, and in accordance with Bear Aware best practices. I understand that personal information contained in this form will not be released to the public except as required by law. For questions about the collection and use of this information, I acknowledge that I may contact the Information and Privacy Coordinator at the District of Squamish on 604.815.5006 or email privacy@squamish.ca. DD / MM / YYYY Full Name of Applicant (please print) Signature of Applicant Date DD / MM / YYYY Full Name of Owner #1 (please print) Signature of Owner #1 Date DD / MM / YYYY Full Name of Owner #2 (please print) Signature of Owner #2 Date All Property Owners must sign this application before submission. Copyright 2013 District of Squamish www.squamish.ca Last Updated: 9 August 2013 Page 6 of 6