HomeMy WebLinkAboutB12-0408 REV2 Transmittal.pdf - Department of Community Development
75 South Frontage Road
0 � VA � L vain , GD 81 fi5?
TOWN Te! : 970.478,2128
wwwmaiigov,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 permi#s. A two hour minimum building review
fie of $110 will be charged upon reissuance of the permit.
ApplieationlPermit #(s) Information applies
to-:
Attention ; (] Revisions
� Response to Correction Letter
B-12-0408 Miner Residence Martin Haeberle �attacted copy afi c�+rrre�tivn letter
�O Deferred Submittal
Revision No. 2 0 Other
Project Street Address :
5030 Prima Court West
( Number) (Stre et) (Suite #j
Building/Complex Name: Description of Transmittal) List of Changes, Items Attached ;
Replace garage door, modify design of entry door, add
Applicant Information
(6 ) new highs efficiency recessed can exterior light fixtures
(archaltect, contractor, owner/owner's rep)
and delete (2 ) existing wall mount exterior light
Contact Name: Rippy Construction
fixtures ( See Sheet A- 1 ) , modify roof above entry deck
Address: P .O. Box 3614
Eagle CO $ 1631 and increase driveway area .
Gity � State : Zip:
Contact Name: Michael, Rippy ( end . Danny Swertfeger) (use additional sheet if necessary}
Contact Phone: (970 ) 977-0217
Building Permits:
michaelri ri mai . cam 'Revised ADDITIONAL Valuations (Labor & Materials)
Contact E-Mail' P��'• ppy�� l ��
ADO NOT include original valuation)
I hereby acknowledge that 1 have read this application, filled out Building : $
I
n full the information required , completed an accurate plot plan ,
and state that all the information as required is correct. I agree to p lumbing: $
comply with the information and plat pion , to comply with all Town
ordinances and state laws, and to build this structure according Electrical : $ 1 . 500.00
to the town's zoning and subdivision codes, de 4n review ap-
proved, International Building and ResldentgVdodes and other Mechanical: $
ordnance 1 f the Town applicable '.JnArairvel'
Total- $ �� � � � 0 0
J� Z
Owner/Owner's R r taiive ture {Required}
Date Received:
For Once Use duly:
Fee Paid:
Received From:
Cash Check #
CC: Visa / MC Last 4 CC # exp. date:
Authorization