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HomeMy WebLinkAboutDRB110573 ILC ;«�:::::.:. .. /"��� Deparfrnent of Comrnunity Development 75 South Frontage Road �}�?�r��,�� �� �A��.:�-� va�i,C Q 81657 Tel: 970.4792128 www.vaiigov.com Development Review Coordinator TRANSM ITTAL FQRM Use this form when submitting additional information for plan�ing applications or building permits. This form is also used#or requesting a revision to building permifs. A two.hour minimum building review fee of$910 will be charged upon reissuance of the permit. � ' ------------------------------------------------------------------------------------------ - ApplicationlPermit#(s)information applies to: � �� f Attention: �Revisions � �Response to Correction Letter � �O� �-�- �_attached copy of correction(etter ��� .I.l•`o�(�� ��� � � -��� (�Otherred Submiital Project Street Address: - ��� �-=�cz� 1 � I (Number} (Street) (Suite#) Building/Complex Name:��• � r i �C'/���� Description of TransmittaU List of Changes, Items Atfached: � � applicant Information (archifec�,contractor,owner/owner's rep) � Contact Name: ' G. � � � Address / U� v � City V d State:� Zip: ! Contact Name: � � 1 ^ �l (use addifional sheet if necessary) � ��7�,��o ��_�Z� -=--_-r-=__=_:-_--__-__:__-_:___.__--_=_-___---__-___-__-_-__--:-_._-_---_--__� Gantact Phone: �Building PermiEs: .�[�I„^ _/`J�W'I�S � Revised ADD{TIONAL Valuations(Labor&Materials) Contact E-MaiL' ���C�v!I/� 1 `F'-'�J L�a <</ E%? O NOT include original�aluation) I herehy acknowledge that I have read this application,filled out Building: $ in full the information required,completed an accurate plat plan, and state that all the information as required is correct. I agree to Plumbing: $ comply with the informa6on 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 des an ther Mechanical: $ ordinances of the Town a plicable t r � � � Total: $� Owne�lOwner's Representative ignature(Required) ------------------------------------------------------------------------------------------------------ Date Received: (� � � r� oM � ForOfficeUseOnly: �� '-+i �, MAR �� 2013 Fee Paid: �I�l i + Received From: i �, Cash Check# ' ���"F9�; t CC: Usa/MC Last 4 CC# exp.date: `_""' ��� �����` ; Authori�tion#