(Please print on green paper)

							                                                                                                                      (Please print on green paper)


                                               CITY OF VANCOUVER
                                               OFFICE OF THE CHIEF BUILDING OFFICIAL
                                               Community Services, 453 West 12th Avenue, Vancouver, BC, V5Y 1V4

                                               REQUEST FOR ACCEPTANCE OF EXISTING CONDITION
                                               WITH MITIGATING FEATURES
                                                (For Existing Buildings Only)

_________________                 _______________________________________                             _______________________
Building Permit No.               Project Address                                                     Date


 For office use only

 Payment $ _______________                          Invoice Number: ____________________               AL Number:   AL____________________


 APPLICANT INFORMATION                                                                                    (Professional Seal)

 Proposed By: __________________________________________________________________

 Firm: _________________________________________________________________________

 Address: ______________________________________________________________________

 Phone: _______________ Fax: _______________ Email: _____________________________


 CODE REFERENCE(S) & SUMMARY OF DEVIATION(S) FROM VANCOUVER BUILDING BY-LAW:




 BRIEF PROJECT DESCRIPTION:




 For office use only

 PROPOSED REQUEST FOR ACCEPTANCE OF EXISTING CONDITION IS:

     ACCEPTABLE                ACCEPTABLE (Subject to condition(s) noted below)            REFUSED (For the reason(s) noted below)
 _____________________________________________________________________________________________________
 _____________________________________________________________________________________________________
 _____________________________________________________________________________________________________


     ______________________________________                                                         ______________________________
     CHIEF BUILDING OFFICIAL                                                                        DATE
 cc: Sender/Certified Professional                      Manager, Processing Centre (Buildings)                 Engineer/Project Coordinator
     Chief Building Official                            Manager, Building Inspection Branch                    District Building Inspector
     Deputy Chief Building Official                     Manager, Plumbing & Gas Inspection Branch              District Electrical Inspector
     City Electrical Inspector                          Other Department _____________________                 Sprinkler Plan Reviewer
     Building Policy Engineer                                                                                  FILE
SUMMARY OF EXISTING CONDITION WITH MITIGATING FEATURES CONTINUED:
 OBJECTIVE(S) OF THE VANCOUVER BUILDING BY-LAW REQUIREMENT(S):




 SUMMARY OF MITIGATING FEATURES:




 ANALYSIS AND EVALUATION TO VALIDATE ACCEPTANCE:




 For office use only

 STAFF COMMENTS AND RECOMMENDATIONS:

      Attached             Noted in Prism

 Comments By: _____________________________ Position: _______________________                               Date: ___________________

 REVIEW PANEL COMMENTS:




 Comments By: _____________________________ Position: _______________________                               Date: ___________________

H:\CBO\01 Administration\01-0500 Policies and Procedures\22 Departmental policies and procedures\Bulletins\2007 VBBL\2000\063_Existing
Conditions form.doc