HomeMy WebLinkAboutB12-0510 REV1 TransmittalDepartment of Community Development
75 South Frontage Road
Vail, CO 81657
TOWN OF Tel: 970.479.2128
wwv+r.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:
gl� - CAS Jl,
?P _S . 0
Project Street Address:
-,,-e en Pt Icw c
(Number) (Street) (Suite #)
Building /Complex Name:
Applicant Information
(architect, contractor, owner /owner's rep/)
Contact Name: -IA v,d Z e re c �
Address: 0' ) 6,,,e 3q i Y
City 4- State
Contact Name:
Attention:
� o Zip: S_ 6 3/
Contact Phone: � 70 ?% - 5 5 / /
Contact E -Mail: da v;d @ vCzt I b :1d;A4 SPrvi CES
0041
1 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
ord of the T appli ✓ e thereto.
X ;7s s-
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 #
C)"Revisions
Response to Correction Letter
❑_attached copy of correction letter
C) Deferred Submittal
(C) Other
Description of Transmittal/ List of Changes, Items Attached:
P) C-Je
A)C-a hkr %u o 1-
(use additional sheet if necessary)
Building Permits:
Revised ADDITIONAL Valuations (Labor & Materials)
(DO NOT include original valuation)
Building:
Plumbing:
Electrical:
Mechanical:
Total:
Date Received:
$0
D ECIR P W E
OCT 2 5 2012
TOWN OF VAIL