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SCURILE_1,
APPLICATION FOR AN ROUIWALERYT ONOER THE B.C. BOXED Cons

APPLICATION DATE:

I/We hereby make an application under Section 2.5 of the British Columbia
Building Code for an equivalency toa:

BUTLEING CODE/REGULATION REFERENCE:

BUILDING PERMIT NO: ~. ADDRESS OF PROJECT:

PARTIAL LEGAL DESCRIPTION: Lot #

Addreza Addresa

City City

Postal Code Telephone/Fax Poatal Code Telephone/Fax

ARPLICANT i. A description of the
proposed measures muat he
attached to this form.
Name ae Documentation supporting
the equivalency to be attached
to thia form.
Signature 3. If information is supplied
by a registered professional a
letter of assurance may be
Telephone/Fax required by the Budiding
Inspector.
&. A letter of assurance may
be required before occupancy
ie approved.

ANAHAAAAAWRAARAR ARRAN ATRIA
*OVFICE USK OMLY "
] *

WRee Paid: CHC ) CAC )*
* *

WReceipt BiH: 0 ) BC ) AC )* CEROVINCE OF BRITIGN COLUMBIA)
* ft

WHAWAARARAARREAH REAR RAERRR RAR