HomeMy WebLinkAboutB12-0366 REV2 transmittalDepartment af Community Development
���`_;:� 75 South Frontage Road
�£���f� �� VAl�: :: � va�i, co s�s�7
Tel: 970.4792128
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
� � I � _ � j � � ,...� � Response to Correction Letter
,f � Q_attached copy of correction letter
�-� _\ L � Deferred Submittal
� � � i c�- � � ( � t"► �Other �l�(�is�[�S i� ��ltf-
---- - ------------------------------------------------------------------- ----------------------------------------------------------------------------------- - - ---I�t�-�t�----SL ---r�'�-�---S�Zan�,--
Project Street Address:
1 � 9 S i/r�. [ L �,i �4 t C t �1 (� %�-l�
(Number) (Street) (Suite #)
BuildinglComplex Name:
Applicant Information
{architect, contractor, ownerlowner's rep)
Contact Name: ��5 �(�TE"d�i G{-D. ������
Address:
�o �. 3 7 ,a ��
City 'U' �I.� State: � Zip: �/b ��
Description of Transmittal/ List of Changes, Items Atfached:
5���'fi312 /� L SIL ���d� rV�'
�.1��'�1 ipG�-Tla s �-� � ���,�� �
Contact Name: I�tTb 13%��T� (use additional sheet if necessary)
Contact Phone: �GI7 (i� 3 �C� -�al � � Building==Permits:_-==____=_=___°_______________________-:____=__-_=__=__=--_______=__--_____=_____-___
I 1� ; Revised ADDITIONAL Valuations (Labor & Materials)
Contact E-Mail: l�bp 6� C� S' C�� Cf�; L�6YVl �(DO NOT include original valuation)
v
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-
proved, International Building and Residential Codes and other
ordinance of the Town applicable thereto.
X �� ���
Owner/Owner's Representative Signature (Required)
For Office Use Only:
Fee Paid:
Received From:
��,
CC: �/sa / MC Last 4 CC #
Authorization #
�,e� #
exp. date:
Building:
Plumbing:
Electrical:
Mechanical:
Tot�i:
$
$
�
$o
Date Received:
� � � � V �
D
��y�`r � � ��12
`-f'� 1 ��, � d �'ir��.
70WN OF �/Af _L_ _�=..s