HomeMy WebLinkAboutB12-0276 REV1 Transmittal_> �. Department of Community Development
75 South Frontage Road
3�OWN OF UA(L� ��� va�i, co s�ss�
Tel: 970.479.2128
www.vailgov.com
Development Review Coordinator
TRANSM ITTAL 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:
�l� �� ���
Attention: evisions
(� Response to Correction Letter
�attached copy of correction letter
0 Deferred Submittal
� Other
Project Street Address: ,J
�_ fc�:-�� �5 l�-�'a � �.,1%.
(Number) (Street) (Suite #)
Building/Complex Name: ���1'1�_ �f(5,��(�
Applicant Information
(a�chitect, contractor, owner/owner's rep)
Contact Name: V � � ,�.1 V�•
Address: ���� �' `� lt� ��-P �� � �"-J
1 ��City CL State: Zip:
Contact Name: , )G �\ ��U r �'s-�t
Contact Phone: �1 jLv � ��"� '
Contact E-MaiL ��i'C� 16-�1 '.V�GS� If� f�� l�e� ��
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 uilding and Residential Codes and other
ordinances of the T n applicable thereto.
X� ;
Owner/Owne ' epresentative Signature (Required)
For Oftice Use Only:
Fee Paid:
Received From:
Cash
CC: Visa / MC Last 4 CC #
Authorization #
Check #
exp. date:
Description of Transmittal/ List of Changes, Items Attached:
r -
,.
, 5. � � ;
a� LU Lc `
(use additional sheet if necessary)
Building Permits:
Revised ADDITIONAL Valuations (Labor 8� Materials)
(DO NOT include original valuatioi '
Building:
Plumbing:
Electrical:
Mechanical:
Total:
Date Received:
��
SEP 1 3 z9 �Z
�� �Z?
TOWN OF'V�IL
********+********************************************************+*******+******************
TOWN OF VAIL, COLORADO Statement
***�*****+*+********+******************�**+**************+**+******+*+**************�**+****
Statement Number: R120001807 Amount: $110.00 11/02/201210:22 AM
Payment Method:Credit Crd Init: CG
Notation: MC leonard
hobrega
-----------------------------------------------------------------------------
Permit No: B12-0276 Type: COMBINATION BLDG PERMIT
Parcel No: 2101-092-0300-6
Site Address: 1042 EAGLES NEST CR VAIL
Location:
Total Fees: 55,639.19
This Payment: $110.00 Total ALL Pmts: $5,639.19
Balance: $0.00
****************************************************************�***************************
ACCOUNT ITEM LIST:
Account Code
--------------------
PF 00100003112300
Description Current Pmts
------------------------------ ------------
PLAN CHECK FEES 110.00
-----------------------------------------------------------------------------
TOWN OF UAIL COM DEU
15 S FRONTAGE RD.
VAIL, CO 81651
978-419-2324
1ERMINAL I.D.; 2882
MERCHANT N;
MC PUR
�t��t��t9uk��4149
SALE
BATCH: 000595 I NU : 000006
AUTH:4$132P
NOU 02a 12 09:iq
TOTAL �110.00
LEONpRD J NOBREGA/
��- � �
�
K---- ----- ---------------------------
I AGREE TO PAV A80UE TOiRI R�OUNT
BCCORDING i0 CARU I6&UER RGREEMENI
(MERCHRNT RGREENENT IF CREDIT VOUCHER)
I�RCHAHT COPV