HomeMy WebLinkAboutDRB120517 transmittal additional informationDepartment of Community Development
75 South Frontage Road
TOI�N OF V�II � va�i, co s�ss�
Tel: 970.479.2128
www.vaiigov.com
Development Review Coordinator
TRANSMITTAL FORM
Use this form when submitting additional information for planning applications or building permits.
This form is aiso 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:
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Project Street Address:
(Number) (Street)
Building/Complex Name:
Applicant Information
Attention:
b�—r—��--�
`�,/�L�—� l �
oo(
(architect, contractor, owner/owner's rep)
Contact Name: �� d + �J%�l��
#)
0 Revisions
� Response to Correction Letter
,Qattached copy of correction letter
� Deferred Submittal
� Other
' Description of Transmittal/ List of Changes, Items Attached:
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� -' I'�"� �f�L�(�� ��C�G���O�
Address: �O � ��� ��
City ��� State: � Zip: ��
Contact Name: L�l`� ���v l�i�-.J�.�
Contact Phone: / 7d c/v � �� 3 3
Contact E-Mail: ���1 b� 6�17 c3�� t� t�i
I hereby acknowledge that I have read this application, filled out
in fufl 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-
prove International 'Iding an Residen 'al Codes and other
or nces of the To a lic I heret .
x
Own r/Owner's Representativ Signature (Required)
For Office Use Only:
Fee Paid:
Received From:
Cash
CC: Visa / MC Last 4 CC #
Authorization #
Check #
exp. date:
(use additional sheet if necessary)
Building Pertnits:
Revised ADDITIONAL Valuations (Labor & Materials)
(DO NOT include original valuation)
Building:
Plumbing:
Electrical:
Mechanical:
Total:
Date Received:
$
$0
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� PABCO PREMIER LAl"iINATED
, �IBERC�LASS SNINC�LES
' "I�ARVEST BROUJN"
1-leav� Timber, Fascia,
Deck, Belly Board:
Olympic Semi Transparent
Deck Sta in-
"Garamel"
UJINDOI.US:
Jeld-l.Uen
"Da rk Choco la te"
--♦ Gem�nt Board� Batten Sidin :_
Golorguarc,� by UJoodtone
RUStIG S�rl�s
��Ev�rgre�n��
UJ_INDOUJS _ 3 DOOR TRIM: �
Moorwood Finish�s
"Enc�lish l.Ualnut �G1-��"
Gem�nt �oard Lap_Sid_in�: �
Benjamin Moore Ext�rior
R�ady-Mix
"Lancaster UJhit�"
• STGti� �.=,;,� :
Robinson Rc��c
"Kiami�h
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O'BRYAN
PARTNERSHIP, INC.
ARCHITECTS — A.I.A.
� ARCHITECTURE,
jPLANNING, INTERIORS
P. O. Box 2773
620 Main Street, Suite 8
Frisco, CO 80443 ��.
Tel: 970.668.1133 ��,
Fax: 970.6682316 �I
www.oparch.com �'
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