fas gta Td
ie NA

een,
a ah ' ine
Jat

Toe he
rity ie ne

iy : : ny 5 fest , ¥
¥ i Chai " ep 4 LEY, ‘fey’
aes ' i. Ciara ; ut uy 4 he eA Hoi pe ‘! sar * ey! ‘ A
ie Z . P PCM 1 gual pte ‘e Uy 28S) antag

APPLICATION FOR AN EQUIVALENY UNDER THE BC BUTLDING CODE

APPLICATION DATE:

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

BUILDING CODE/REGULATION REFERENCE:

BUILDING PERMIT NO: ADDRESS OF PROJECT:

PARTIAL LEGAL DESCRIPTION: LOT NO. PLAN NO.

OUNER ; REGISLERED PROFESSIONAL

Name ; Name

Address Address

‘

City . City

Postal Code) — Telephone/Fax Postal Code Telephone/Fax

1. A description of the proposed
measures must be attached to this

form.

2. Documentation supporting the
equivalency: to be attached to
«enn this form. _—
Signature | | ;
3. If information is supplied by |
a vegistered professional a
Telephone/Fax . letter of assurance may be
mae | | required by the Building
Inspector. — | _ 7

| 4, A letter of assurance may be
a | | | required before occupancy is
PRAIA IIIRIEAD AREER RARER _ approved. : _
* OFFICE USE ONLY | * _ -
Fee Paid: CHC ) CAC ) * ss (PROVINCE OF BRITISH COLUMBIA) —
rs oe ae | Be -_
Receipt Bis_ o( ) BC ) AC )*®-
ee ce *

PRAIA AIR ITI IAA AAI AIT R IAL II AI

. ‘

SEAL

po

311 PAGE.