HomeMy WebLinkAboutB12-0565 transmittalDepartment of Community Development
75 South Frontage Road
�-��� �� ,����� �� Vail, CO 81657
Te I: 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.
_._.. _. - - -
ApplicationlPermit #(s) information applies
to: Attention: � Revisions
��t'� � d�� G � Response to Correction Letter
� J ❑_attached copy of correction letter
� � Deferr d Submittal '
��,v � � ' fl �''Jcri� �� Other�4,M[�1)� '��,�� QIi� �j l' ;
- - --- - _ _- -- 3
Project Street Address:
�fr2, 7�.�'�1,� Ck—��
(Number) (Street) (Suite #)
Building/Complex Name: �� �N V` L�
Applicant Information
', (architect, contractor, owner/owner's rep)
'�, Contact Nam���Q��I`Ok� f�
I Address�� � � f 1
i City�� StateG� Zip: �r
', Contact Name: �DYI � - �
� Contact Phone: �� d �� � ��' �
��, Contact E-Mail:����� e� 111�,.[��b�%'D . C O1(�
i �
�I 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-
I prov Intern 'onal Building and Residential Codes and other
' r i n s of th Town applicable thereto.
' Owner/O r's Representative Si ature (Required)
I. _ _ s_ � s._ _r.__ _,__._._ _ .._ _ ---4. _� -----_. . ._...... e -. _.._..._.
For OfficeUseOnly:
Fee Paid:
Received From:
Cash
CC: �lsa / MC Last 4 CC #
Authorization #
Check #
exp. date:
Description of Transmittal/ List of Changes, Items Attached:
Re,�m��. �4� 7s,a� Lfl�1�sc-���,
�Q�ne�d�l Q��o.c FR��r� �e�^m;fi
i'� �,'�'�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:
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TOWN (�F VAIL