HomeMy WebLinkAboutB12-0400 Transmittal�..�.�- .
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Use this form when su
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Department of Community Development
75 South Frontage Road
Vaii, CO 81657
Tel: 970.479.2128
www.vailgov.com
Development Review Coordinator
TRANSM ITTAL FORM
ng additional information for planning applicatio s or buiiding 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. __ __.__,
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Application/Permit#(s) information applies �Revisions ,
to: Attention:
� Response to Correction Letter ?
�/� � D�U► O 0_attached copy of correction letter �
� � Deferred Submittal �
- I� Other s
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Project Street Address: �
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(Number) (Street) (Suite #)
BuildingtComplex Name:
Description of Transmittal! List of Changes, Items Attached:
. 1
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Applicant Information � �
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(architec , contractor, wnerlowner's rep) �
Contact Name: ,�o_v 1 C1' �-� � i
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Address C� `,t�X � 3�3 � �
City �S�'d S t� ✓� _ State: ��'%Zip: �g 6�7 �
Contact Name: �� 1/ 1(' �+-�� (use additional sheet if necessary) �'
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Contact Phone: / 7d —� 3 � ���� ; Building Permits
' 1 i Revised ADDITIONAL Valuat�ons (Labor & Materials)
I Contact E-Mail: /"OGKr7 0�0 �� ��'� ' C� �'(DO NOT include original valuation) �
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i I hereby acknowledge that I have rea d t his app lica tion, f i l l e d o u t EE B u i l d i n g: $� 7 dv
' in full the information required, completed an accurate plot plan, ; $
and state that all the information as required is correct. I agree to ; Plumbing:
', comply with the information and plot plan, to comply with all Town ' $
'' ordinances and state laws, and to build this structure according 3 Electrical:
to the town's zoning and ubdivision codes, design review ap- ; $
' proved, International B� ding and Residential Codes and other 3 Mechanical:
'� _ ordinan�s of the To n applicable theret � $ �
� Total:
Represenfiative Signature (Required)
Date Received:
For Office UseOnly:
Fee Paid:
Received From:
�� Chedc #
CC: Usa / MC Last 4 CC # exp. date:
Authorization #
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