HomeMy WebLinkAboutB12-0474 REV1 100812 TRANSMITTALDepartment of Community Development
0 75 South Frontage Road
Vail, CO 81657
TOM OF VAI Tel: 970.479.2128
www.vailgov.com
Development Review Coordinator
TRANSMITTAL 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:
PQ T 1,- a/
Project Street Address:
(Number) (Street) (Suite #)
Building /Complex Name:
Applicant Information
(architect, contractor, ` owner /owner's rep)
Contact Name: TA ii') CQ L D RA�) Cl n
Address:
Attention:
Revisions
Response to Correction Letter
attached copy of correction letter
Deferred Submittal
Other
Description of Transmittal/ List of Changes, Items Attached:
CR IAVo'e- SIZE OF q1)
oc��21N Lori
City State: Zip= !
Contact Name: �2E'� T �(iR2o (use additional sheet if necessary)
Contact Phone:
Contact E -Mail
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 I s I with all Town
ordinances and s ,and to build this structure ccording
to the to ' ng and sub i i codes, des ap-
pro ernati al Build n . en ial Codes nd other
rdi n es of th a I le t eAeto.
Owner /ONner's Representative Signature (Required)
For Office Use Only:
Fee Paid:
Received From:
rash
CC: Visa / MC Last 4 CC #
Authorization #
Check #
exp. date:
Building Permits:
Revised ADDITIONAL Valuations (Labor & Materials)
(DO NOT include original valuation)
Building:
$_
Plumbing:
$-
Electrical:
$_
Mechanical:
$_
Total:
$ 0
Date Received:
OCT 0 2012
2�y�PM
TOWN OF V IL