HomeMy WebLinkAboutB12-0019 REV1 TRANSMITTAL '^ Department of Community Development
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75 South Frontage Road
-*vA Vail,CO 81657
TO IN Q F VA: ` Tel: 970.479.2128
www.vailgov.com
Development Review Coordinator
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TRANSMITTAL FORM
Use this form when submitting additional information for planning applications or building permits.
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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.
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ApplicationlPermit#(s)information applies
to: Attention: O Revisions
Response to Correction Letter
0_attached copy of correction letter
l 1y O Deferred Submittal
(0 Other
Project Street Address:
(Number) (Street) (Suite )
BuildinglComplex Name: < '� Description of Transmittal/List of Changes, Items Attached:
Applicant Information
(architect,contractor,ownerlowner's rep)
Contact Name: C
Address: �7
City VCJ State:
Contact Name: 1,1<e yJ I/�F C� (use additional sheet if necessary)
Contact Phone: ! 76^ 10LI-1Z Building Permits:
+ Q Revised ADDITIONAL Valuations(Labor&Materials)
Contact E-Mail: KeV 1✓L KJ eel\IUD-1 1� C (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 Building and Residential Codes and other Mechanical: $
ordinances of the Town pppli thereto.
Total: $B
Owner/O er's Re ntative Signature(Required) --------------------- ----------------------------------------------------------------------------
Date Received:
For Office Use Only: D
Fee Paid: MAR 08 2013
Received From:
Cash Check#
CC: Visa!Mc Est a CC# exp.date: TOWN OF VAIL
Authorization#