Southwest British Columbia has the potential to experience large-magnitude earthquakes generated by the Cascadia Subduction Zone (CSZ). Buildings in Metro Vancouver are particularly vulnerable to these earthquakes because the region lies above the Georgia sedimentary basin, which can amplify the intensity of ground motions, particularly at medium-to-long periods. Earthquake design provisions in Canada neglect basin amplification and the consequences of accounting for these effects are uncertain. By leveraging a suite of physicsbased simulations of M9 CSZ earthquakes, we develop site-specific and perioddependent spectral acceleration basin amplification factors throughout Metro Vancouver. The M9 simulations, which explicitly account for basin amplification for periods greater than 1s, are benchmarked against the 2016 BC Hydro ground motion model (GMM), which neglects such effects. Outside the basin, empirical and simulated seismic hazard estimates are consistent. However, for sites within the basin and periods in the 1-5 s range, GMMs significantly underestimate the hazard. The proposed basin amplification factors vary as a function of basin depth, reaching a geometric mean value as high as 4.5 at a 2-s period, with respect to a reference site located just outside the basin. We evaluate the impact of the M9 simulations on tall reinforced concrete shear wall buildings, which are predominant in the region, by developing a suite of idealized structural systems that capture the strength and ductility intended by historical seismic design provisions in Canada. Ductility demands and collapse risk conditioned on the occurrence of the M9 simulations were found to exceed those associated with ground motion shaking intensities corresponding to the 975 and 2475-year return periods, far exceeding the ∼500-year return period of M9 CSZ earthquakes.