HomeMy WebLinkAboutB12-0544 REV1 101112 TRANSMITTALDepartment of Community Development
75 South Frontage Road
Vail, CO 81657
TOWN OF VA1L . '� 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: Attention: Revisions
`C) Response to Correction Letter
jZattached copy of correction letter
0 Deferred Submittal
_ D Other
I 912. -5 i X _2 --,
Project Street d re j
(Number) (Street) �\ (Suite #)
Building /Complex Name:
Applicant Information
(archite contract wner/own s rep)
Contact Name:
Address:
City —; J 64Gx� = State_ Zip: �((dZd
Contact Name:
Contact Phone:
Contact E -Mail:
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
or ance and state laws, and to build this structure according
to ning and subdivision codes, design review ap-
prov , nt ati nal Building and Residential Codes and other
ordina s t Town applicable thereto.
Owner /Owner's Representative Signature (Required)
For Office Use Only:
Fee Paid:
Received From:
Cash Check #
CC: Visa / MC Last 4 CC # exp. date:
Authorization #
Descri tion of Tr smittal/ List of Chang , Items Attached
I Cr
K --A
1 1^
y
c
(use additional sheet if necessary)
Building Permits:
Revised ADDITIONAL Valuations (Labor & Materials)
(DO NOT include original valuation)
Building: $
Plumbing: $
Electrical: $
Mechanical: $
Total: $ 0
Date Received:
OCT 1 12012
M.*- /0 `1 0
TOWN OF VAIL