Please complete all relevant sections of this form (areas marked in blue), print it out, and attach copies of key research documents for reference.
We recommend that you refer to the historic building research guide for assistance filling out the nomination form.
Part 1: Property Description
Where you can find it:
 Land Title documents
 Survey plan of the property
Legal Address of Property: Click here to enter text.
Legal Description: Click here to enter text.
Part 2: Historic Building Construction Information
A. Water Service/Permit Records
Where you can find it:
 Water/Sanitation Inquiries, Main Floor, City Hall
 City Archives
Instruction: Fill out the following information, and attach a copy of the record to this form (alternatively, you can attach copy of the building permit)
Date of Water Permit: Click here to enter text.
B. Building Permit(s)
Where you can find it:
 Property Information Counter, Data Resource Centre, 2nd Floor, East Wing, City
Hall
 City Archives

Instruction: Fill out the following information, and attach a copy of the permit to this form
Date of Building Permit: Click here to enter text.
Builder: Click here to enter text.
Original Owner: Click here to enter text.
Architect (if applicable): Click here to enter text.
Date of Additions (if applicable): Click here to enter text.
C. Property Tax Assessment
(Note: Attach a copy of Property Tax Assessments, only if there is no other information available for water or building permits, and if your building is pre-1889 or post-1930)
Where you can find it:
 City Archives
Instruction: Attach a copy to this form
D. Architectural Plans
Source and Reference Number Where Found: Click here to enter text.
Architect Listed: Click here to enter text.
Date of Plan: Click here to enter text.
E. Fire Insurance Maps/Plans
Where you can find it:
 City Archives; Vancouver Public Library
 UBC Special Collections
Instructions: Fill out the following information, and attach copies of maps or plans to this form
Maps Consulted (e.g. Point Grey 1922 vol xi page 2):
Click here to enter text.
Date of Earliest Fire Insurance Map/Plan Where Building is Shown:

Click here to enter text.
F. Historic Photographs
Where you can find it:
 City Archives
 Vancouver Public Library
 UBC Special Collections
 British Columbia Archives
Instruction: Fill out the following information, and attach copies of original photographs
Date of Construction Based on Sources Referenced Above (specify estimated date or actual date):
Click here to enter text.
Describe and date any alterations/additions made to your building since its construction (Note: these may be documented in the Building Permits and
Fire Insurance Maps/Plans):
Click here to enter text.
Part 3: Historic Ownership Information:
List of All Pre-1950 Owners and Dates
Where you can find it:
 City Directories
 Historical Land Title Search
Instructions: Attach the list of owners and a copy of Title Search to this form
(Optional: Include list of owners since 1950/Research further biographical information on significant owners or events associated with the building/ Attach copies)

Part 4: Current Building Information
A. Current Photographs of the Building
Instruction: Fill out the following information, and attach photographs including front, rear and side views, with a focus on unique details and any alterations (if applicable).
Optional: Include photographs of significant exterior or interior features (if applicable)
Zoning: Click here to enter text.
Use: Click here to enter text.
Name of Neighbourhood: Click here to enter text.
Describe the condition of the building:(i.e. Generally excellent, good, fair or poor)
Click here to enter text.
Additional comments on building condition:
Click here to enter text.
B. Context
Describe the neighbourhood and how the building relates to the general character of the area and the surrounding land uses.
(Example: Does this house make up a larger row of heritage /character homes or is it a lone survivor surrounded by more modern development?)
Click here to enter text.
Describe the property's landscape/garden and any special trees and/or features. Include any notes about the building's status as an area or neighbourhood landmark, and how the building is sited on the lot.
Click here to enter text.
Are you the current owner?
If not, is the owner aware of this nomination and supportive?
(Attach a letter of support from the owner or indicate why it cannot be provided.)

Attachment checklist
Have you included:
 Attachment 1: A complete list of all owners and dates prior to 1950?
 Atachment 2: Current and archival photographs (if available)?
 Attachment 3: Copies of plans and maps?