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BUILDING PERMIT APPLICATION
Separate applications are required for alarm & sprinkler)
Project Street dd ss: ` Project #: _Q - ' (
a25 n —
Numberl (Street) (Suite #) DRB #: J ' '
Building/Complex Name:/U' V'' ` Building Permit #: — J
r..,.. .. . ,.. _ ._.. ..__ _ . . . _ . _ _ ._ Lot #: Block # Subdivision:
Contractor Inform tion
Business Name. " 1 1 ; Work Class: New ( ) Addition O Alteration O
tr-, ._.._ .,.._._ _.___ ,...__.. _.,.,.....__._____ ___......_____..:
Business Address. l V \ ; Type of Building• -
City State: Zip: Single-Family O Duplex O Multi-Family (
M, Commercial ( ) Other ( )
Contact Name:
Contact Phone:-1 V ' UZ " I CJ ; Work Type: Interior ( Exterior ( ) ,Both (
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Contact E-Mail:{'1K-.I+.0 {,'I r.l 1 , X • (.,3'(Y _ _ _____ _..._ .._ __..._._...
R.__._..m_._.,,........r,.T-..
Valuation of
Work Included Plans Included Work
Contractor Registration Number.
Electric I Yes No Yes ( )No ,
i('., /" jMechanical ( )Yes ( )No ( )Yes ( )No 70;
Owner/Owner's Representative Signature (Required) Plumbir g ( )Yes ( )No ( )Yes ( )No a
Praject Infor on ` Buiiding ( )Yes ( )No ( )Yes ( )No
owner Name\C P IKx.v1 (%, ,
Parcel #: l.\ O `J `U "\ .
Value of all work being pertormed: $- o.
For Parcel #, contact Eagle County Asaessors Office at (970-32&8640 or vlsit -velue ba ed on IBC Sectfon 109.3 & IRC Section 108.3
www.eaglecounry.us/petle) ; Electrical Square Footage
Detailed Scope and Location of Work:
use additional sheet if ne essary)
For Of6ce Use Only:
Fee Paid: ` 0 '
Received From:
Cash Check # .
CC; Visa / MC Last 4 CC #
At th #
exp date:
0
Date Received:
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JUL 12 2012 ;
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