HomeMy WebLinkAboutB13-0023 REV2 TRANSMITTAL f Department of Community Development
(, 75 South Frontage Road
1 ,>
1:�Ti���} UF �A�� Vail,co 81657
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
fee of$110 will be charged upon reissuance of the permit.
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Application/Permit#(s)information applies
to: Attention: Revisions
/� Response to Correction Letter
L�/•L�IJ/I��f- 0_attached copy of correction letter
C)Deferred Submittal
(C)Other
Project Street Address:
(Number) (Street) (Suite#)
Building/Complex Name: pOZ�Ci+4AdG /�It.�/�1A' 11�j Description of Transmittal/List of Changes, Items Atfached:
Applicant Information r'"ad owl
(architect,contractor,ownerlowner's rep) (�
Contact Name: /1�0 BKL L /Q6P�r r t 120"Wo
Address: Zo,is • 1_?0 X 7S
City )22) 4/21!W State:�_Zip: 4r/F V
Contact Name: F.Z 77 ✓ g),/ (use additional sheet if necessary)
Contact Phone: 1-7o. 3 9Q. 7121 l / Building Permits:
Revised ADDITIONAL Valuations(Labor&Materials)
Contact E-Mail: DO NOT include original valuation) �y
I hereby acknowledge that I have read this application,filled out Building: $ JS i DDD —
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 lays, 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: $
ordinanc f the Town app icable ere
x Total: $B �/GO O
Owner/Owner's Representative Signature(Required) --------------------------------- --------------- ------------------------------------------------
Date Received:
D CC EE WE
For Office Use Only: APR 0 3 2013
Fee Paid:
� Received From:
Cash Check# TOWN O F VA I L
CC: Visa/MC Last 4 CC# exp.date:
Authorization#