HomeMy WebLinkAboutB12-0315 REV1Department of Community Development
75 South Frontage Road
TOII�N OF VA�L � vai�, co s�ss7
Tel: 970.479.2128
www.vailgov.com
Development Review Coordinator
TRANSM ITTAL FORM
Use this form when submitting additional information for planning applications or building permits.
This form is also used for requesting a revision to building permits. A two hour minimum building review
fee of $110 will be charged upon reissuance of the permit.
Application/Permit #(s) information applies
to:
g �:- o3t5
��-Ic:.,. Cviee� i r�,.�s :-� S � �t✓
Attention:
I ��d�� v�
b'V �. i /�2v�.
Project Street Address:
�� 7 � in Lv� ✓ w 1� -
(Number) (Street) (Suite #)
Building/Complex Name: ��i-�:•� �� � ya�S � SW+�
Applicant Information
(architect, contractor, owner/owner's rep)
Contact Name: I�•� . e.l�aa-I �w��v�
Address: �- i� • /� D�C �` c�—�
City � do � S State: C� Zip: �� 6Q�
Contact Name: I�;��, � � k.�n.�✓�—
Contact Phone: t C� `(7 � O' � 7d--I
Contact E-Mail: �5�,���-S1r�Pl� � 4,IMU� I, C�'�
I hereby acknowledge that I have read this application, filled out
in full the information required, completed an accurate plot plan,
and state that all the information as required is correct. I agree to
comply with the information and plot plan, to comply with all Town
ordinances and state laws, and to build this structure according
to the town's zoning and subdivision codes, design review ap-
proved, International Building and Residential Codes and other
ordinances of the Town applicable thereto.
X
OwneNOwne s� Representative Signature (Required)
For Office Use Only:
Fee Paid:
Received From:
Cash
CC: Vsa / MC Last 4 CC #
Authorizabon #
Check #
exp. date:
Q'F2evisions
(� Response to Correction Letter
�attached copy of correction letter
0 Deferred Submittal
� Other
Description of Transmittal/ List of Changes, Items Attached:
/�l ; ti�� e t.e. i,.e� s �v i�,N.,, �rAn•. �'t�
c- �na �q a ��- � ro..` � � N/oa�
�-� S ��wa�� 72� ��.. C`�
`D//t� /'�r �.� Lcf�
��,� � �c�✓'2S a� /1 �
(use additional sheet if necessary)
Building Pertnits:
Revised ADDITIONAL Valuations (Labor 8� Materials)
(DO NOT include original valuation)
Building:
Plumbing:
Electrical:
Mechanical:
Total:
Date Received:
,
5� � ��
$
$0
L� � � U �
SEP 13 2012
TOWN OF VAIL
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