HomeMy WebLinkAboutB12-0612 transmittalDepartment of Community Developmer
75 South Frontage Road
Vail, CO 81857
TOWN Of VAIL Tel: 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
f- nf Ti in will he charged upon reissuance of the permit.
_____________
Application /Permit #(s) information applies
to:
1312- (DL"
Project Street Address:
)DO A
(Number) (Street) (Suite #)
Building /Complex Name:
Applicant Information
Attention:
(architect, contractor, owner /owner's rep)
Contact Name:`
Address: Pte�� r,:"5; Z*
City E"-&X(,_ State: C,0 zip: �� I
0 Revisions
*'Response to Correction Letter
_attached copy of correction letter
Deferred Submittal
Other
Description of Transmittal/ List of Changes, Items Attached:
�V'lA :12h"-S .
W inn �1 bw 2 - pC Cn
Contact Name: CSC —�1/t (use additional sheet if necessary)
Contact Phone:
c1 TO - - 26 2S) 2 Building Permits:-___ _________
Revised ADDITIONAL Valuations (Labor & Materials)
Contact E -Mail: OA P-C-AoW M K;�v vi+a "^ (DO NOT include original valuation)
I hereby acknowledge that I have read this application, filled out Building: $
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 Electrical: $
to the town's zoning and subdivision codes, design review ap-
proved, International Buildin and Residential Codes and other Mechanical: $
ordinances of the Town appl ble thereto.
X 1 Total: $ 0
Owner /Owner's Represe tative Signat a (Required) ---- -- - - - --
Date Received:
For Office UseOnly:
Received From:
Cash Check #
CC: Visa / MC Last 4 CC # exp. date:
Authorization #
DEC 10 2012
CC-) 3`co
TOWN OF VAIL