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°ROPOSED NEW 30X8i�
d�OR TO MATCH THE STYLE
OF THE OTHER DOORS
NfIiHiN THE UNIT
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PiCTURE WIf�DOW
EXISTING 72X80 SLlvING DOrJR
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PROFOSEDI�I�W WALL��
5/8" G.W.B. ON BOTH'�ID�ES OF
� 2x4 WOOD STl}D 1(VALL P�
CONSTRUCTION. PR�O�VDE
S�UND Ai"TENUA�f'lb9v
INSULAT�QI�
BETWEEN STUD���
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27'-0"
EXISTING 30X48
CASEMENT WINDOW
EXISTING 102X48
PICTURE WINDOW
11'_5�"
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PROPOSED
RECESSED
CAN LIGHT
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Nationat Gypsur� CoMpany
Gwsum Wdlbamd Floa/Cedina—Wood
No.
STC Test No. IIC
INq.E UYER No Capd fapd t P�i
I hr. UL L501 5/8'(159mm)Firc-9idd Gpwm MdboQd a 5/8' 31 Based m 3� 66
GA FC 5420 (15.9mm)FS Sof6t BoQd nai attad�ed to 1�10 NGC 4024
(38mm x 241mm�ood joists spoced 16'ac
{�as�,�u a��rn�n oPS���
T�e�o��r�a.
GA FILE NO.FC 5415 I I PROPRIETARY' I
WOOD JOISTS.GYPSUM WALLBOAflD,RESILIENT CHANNELS
Onc I �ri=e C rpn�hry NPF X:7YPSUm wollLxr rd oi,yypsmn veneer bc�se app6ed at n9ht
n;il..I i r..il�it lumn3 chauneds iG n c uiih 1'Type S ihyxall u�ietv+17 < �
l yp5�nn 6 i ud nd joints Iocatcd miJwuy bch,vco:n con�i nuou+ch�anob:md altached ki
ad I�honal F ier;es ol chnnnel 72'k n�vnth+�.rNV:R o c Resd�en�turnny channels
aFplied ai nghl angtzs to 2�10 noM pi�sts 27 0 .v:rth 6d coatz�naiis 1�'c"kng.
O.i'1 'shark.�;i heeJs.VJow]�oisL sUpf.ortmy ' nnmmal mlerioi plyK�ood wilh
�xf�iw�glu�a T&G suL�loor perpendi u�ir to�oist with loints sta:peied U id�rsule nf
I 8 C,joints%a�eied Geiween�oist spa:es wilh 6 x 221�z x s,e'tW=X gypsum w Ilbua�d
ban�.ns att.a hr,d to fl�iinp v.�ifh 1�g,��c z t 4e 1.3s x >'�r.rnvm st�dus.,p�r.cA� n r..
alanq a:ach..d9e.
PROPRIETARY GYPSUM BOARD
Aruerivan Gypvim C:i+rn{�auy - +'e'PIREBLOC TYPF(:
UPF3 Ameixa U�c � e:�a`ProHoc- fypn G Uypsum Panels
G F'Gypsum � e'Iou3hHuck`.(ireyua�d=(:
Lat�i�c North Amciicti Inc. s�a'Fiic�ch ck��Typc C
ri��a,���:ai a��,:;����c�>,��F,���y e c��i�i������ e�:����i FiRe-sHiet r�c:�„
Gypsum VJal��aid
PAH(:O Gypstun . s;o'f L�A1E GIJNN•:Supnr'G'
I?mple�inland I ores�Ptaducic Cmporatbn - "c'fC9�i;
Uuiled Si:�tas Gypr,wn Coitqaairy . sie"SHFFTROCK•B�and C;�p4uin
Panels.FIH[CppC°�C t;oie
� Unit 227 PLAN
SCALE 1/4' � 1'-0'
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1. COORbINATE LOCATION OF RECESSED CAN
LIGHTING WITH EXISTING STRUCTU�E. USE RATED
CAN LIGHTING, FIRE-TAPED 5/8"G.W g. ENCL�JSURES,
OR TENMAT RATED LtGHTING ENCLOSURE.
MAINTAIN THE EXISTING 1 HOUR RATED UNIT
3�_�° SEPARATION.
�.t�GEND: 2. GENERAL CONTRACTOR TO MEET 2012 IRC REQUIREMENT
� FIRE SPRINKLER(EXISTING) SECTION N1104.1 LIGHTING EQUIPMENT:
� SMOKE DETECTOR(EXISTING) A MINIMUM OF 75 PERCENT OF THE L�MPS IN
PERMANENTLY INSTALLED LIGHTING FIXTURES SHALL
��� RECESSED CAN LIGHT FIXTURE (NEW) BE HIGH-EFFICACY LAMPS.
�� RECESSED CAN LIGHT FIXTURE (EXtSTING)
1 HOUR 35 to 39 STC
FIRE SOUND
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appiox.cclung
VJeir�ht 2.5 pst
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NOTE: THIS PERMIT MUST BE POSTED ON JOBSITE AT ALL TIMES
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Town of Vail, Community Development, 75 South Frontage Road, Vail, Colorado 81657
p. 970.479.2139, f. 970.479.2452, inpsections 970.479.2149
COMBINATION BLDG PERMIT Permit #: B13-0127
Project #: PRJ13-0156
Job Address: 595 VAIL VALLEY DR VAIL Applied.....: 04/29/2013
Location......: Manor Vail Unit 227 Issued. . . : 07/11/2013
Parcel No....: 210108107004
OWNER RYBOK X LLC 04/29/2013
5625 VETERANS MEMORIAL PKWY
SAINT PETERS, MO
63376-1603
CONTRACTOR HIGH MOUNTAIN HOMES, INC 04/29/2013 Phone: 970-376-5475
PO BOX 477
� EAGLE
CO 81631
License: C000003362
Description:
Construction of interior wall to create additional bedroom,
installation of new recessed can lights. Convert tub to
shower.
Occupancy: R-2 Type Construction: VA Valuation: $6,500.00
................................._.._._..__...._.......,........,,,,.,,.....,..... FEE SUMMARY ..,.,.:...........,....,....,.,._•___..,,..x..,...........,..,___................
Building Permit-----------> $153.25 Bldg Plan Check----------> $99.61 Use Tax Fee-----------------------> $0.00
Electrical Permit---------> $172.50 Elec Plan Check-----------> $112.13 Restuarant Plan Review--------> $0.00
Mechanical Permit------> $0.00 Mech Plan Check---------> $0.00 Additional Fees--------------------> $0.00
Plumbing Permit--------> $15.00 Plmb Plan Check---------> $3.75 Recreation Fee--------------------> $0.00
Investigation-----------------------> $0.00
Will Call------------------------------> $15.00
� TOTAL PERMIT FEES--------------> $681.24
Payments-------------------------------> 5681.24
BALANCE DUE------------------------> $0.00
.................,�........,..,........»........,,...........,,...,..._......«.,�...,,....,...........».......,............,,.............._......,.........,.............,,._._..........
DECLARATIONS
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 approved, International Building and Residential Codes and
other ordinances of the Town applicable thereto.
REQUESTS FOR INSPECTION SHALL BE MADE TWENTY-FOUR HOURS IN ADVANCE BY TELEPHONE AT 970.479.2149
OR AT OUR OFFICE FROM 8:00 AM -4:00 PM.
combination permit_012811
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A�kYeR#'Rrt�.tYr#rtrtrtwhhfrfff#i1'eY'Ye#rtVYrYrYrY'fYetrtrrtrthrt#fYr#'�A'#htrtrfYrfhhfitrtrtr+eYeVRfXxlrxlrxffrRl(f4R�lirfir�Fi4#i`R�R'kYeff#fYrRYeYeP'�RwtrtrY(fYrx444fwatxd*1`4ff�f�i`*�kkkYeYertY'Y'Y`V#+Yr�'Y`RRRMf**1�1`1`i(ilNYrYrYrtrhtRlrlrRfix#f#i`i`i`Y`Ye�1rRfrRtrfxRt(R
CONDITIONS OF APPROVAL TO BE MET PRIOR TO FINAL SIGN OFF
�
Permit#: 613-0127 Address: 595 VAIL VALLEY DR VAIL
Owner: RYBOK X LLC Location: Manor Vail
Unit 227
........................................................»......................,.....,,,..,..,.,.,...,........,......,»..........,....,..,,,.,..,.......,,............,...,.......,.,
>
combination permit_012811
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r,r*w w,r**t w t,r,t,r*,r,r,t r r r,r,r*x*,r x**w w*,r*���*t*�,r,r w,t,r,r,r,r,r,r,r,r*rr**:*x,r*****,t,t,t,r r,r,r w r w*�,r�w,r,r,r*t t*,r,t,t,t rr,r**,r,r w**�t t rr,r,r*,r,t,r,r***w,r w w,r,r,r*:*w****,r*,r,r,r***r*�t,r,t,t,r r,r
REQUIRED INSPECTIONS AND STATUSES
i
Permit#: 613-0127 Address: 595 VAIL VALLEY DR VAIL
Owner: RYBOK X LLC Location: Manor Vail
Unit 227
***«*************************«*************************.*****«**««*************�*�***«*«*«*,,,**.,*****************************«*�*******«*«*****�****„
Item: 00120 ELEC-Rough
06/04/2013 By: sgremmer Action: AP
Item: 00030 BLDG-Framing
06/19/2013 By: sgremmer Action: AP
Item: 00050 BLDG-Insulation
06/19/2013 By: sgremmer Action: AP Comments: NA
Item: 00060 BLDG-Sheetrock Nail
06/19/2013 By: sgremmer Action: AP
Item: 00190 ELEC-Final
07/10/2013 By: sgremmer Action: AP
Item: 00090 BLDG-Final
07/10/2013 By: sgremmer Action: AP
combination permit_012811
�
07-08-2013 Inspection Request Reporting - Page 13
4:13 pm Vail, CO - City Of t J_Q(')
Requested Inspect Date: Tuesday,July 09,2013
Site Address: 595 VAIL VALLEY DR VAIL
Manor Vail Unit 227
A/P/D Information
Activity B13-0127 Type: COMBO Sub Type: AMF Status: APPROVED
Const Type Occupancy: Use: R-2 Insp Area:
Owner RYBOK X LLC
Contractor: HIGH MOUNTAIN HOMES, INC Phone: 970-376-5475
Description: Construction of interior wall to create additional bedroom,installation of new recessed can lights.Convert tub to
shower.
Reauested Inspection(s)
Item. 190 ELEC-Final Requested Time: 04:15 PM
Requestor HIGH MOUNTAIN HOMES, INC Phone: 970-376-5475
Comments 376-5475
Assigned To J ' D j- ON Entered By: JMONDRAGON K
Action •I Time Exp:
Rem• 90 BLDG-Final Requested Time: 09:00 AM
Requestor HIGH MOUNTAIN HOMES, INC Phone: 970-376-5475
Comments 376-5475 4
Assigned To S -' Entered By: JMONDRAGON K
Action 4. 6 Time Exp:
1.
Inspection History ��,
Item: 120 ELEC-Rough **A.'roved**
06/04/13 Inspector: sgre mer Action: AP APPROVED
Comment:
Item: 30 BLDG-Framing **Approved**
06/19/13 Inspector: sgremmer Action: AP APPROVED
Comment:
Item: 50 BLDG-Insulation **Approved**
06/19/13 Inspector: sgremmer Action: AP APPROVED
Comment: NA
Item: 60 BLDG-Sheetrock Nail **Approved**
06/19/13 Inspector: sgremmer Action: AP APPROVED
Comment:
Item: 190 ELEC-Final
Item: 90 BLDG-Final
REPT131 Run Id: 14679
__ _ . _ _ _
+*+**************************************************+****************************+*********
TOWN OF VAIL, COLORADOCopy Reprinted on 07-11-2013 at 11:31:06 07/11/2013
Statement
********************************************************************************************
Statement Number: R130000958 Amount: $156.85 07/11/201311:30 AM
Payment Method:Credit Crd Init: CG
Notation: visa austin
thomas
-----------------------------------------------------------------------------
Permit No: B13-0127 Type: COMBINATION BLDG PERMIT
Parcel No: 2101-081-0700-4
Site Address: 595 VAIL VALLEY DR VAIL
Location: Manor Vail Unit 227
Total Fees: $681.24
This Payment: $156.85 Total ALL Pmts: $681.24
Balance: $0. 00
****************************************************************************************+***
ACCOUNT ITEM LIST:
Account Code Description Current Pmts
-------------------- ------------------------------ ------------
BP 00100003111100 BUILDING PERMIT FEES 14 .00
PF 00100003112300 PLAN CHECK FEES 122.85
PP 00100003111100 PLUMBING PERMIT FEES 15.00
WC 00100003112800 WILL CALL INSPECTION FEE 5. 00
-----------------------------------------------------------------------------
NOTE: THIS PERMIT MUST BE POSTED ON JOBSITE AT ALL TIMES
,.
�w�o���, .
Town of Vail, Community Development, 75 South Frontage Road, Vail, Colorado 81657
p. 970.479.2139, f. 970.479.2452, inpsections 970.479.2149
COMBINATION BLDG PERMIT Permit #: B13-0127
Project #: PRJ13-0156
Job Address: 595 VAIL VALLEY DR VAIL Applied.....: 04/29/2013
Location......: Manor Vail Unit 227 Issued. . . : 05/13/2013
Parcel No....: 210108107004
OWNER RYBOK X LLC 04/29/2013
5625 VETERANS MEMORIAL PKWY
SAINT PETERS, MO
63376-1603
CONTRACTOR HIGH MOUNTAIN HOMES, INC 04/29/2013 Phone: 970-376-5475
PO BOX 477
EAGLE
� CO 81631
License: C000003362
Description:
Construction of interior wall to create additional bedroom,
installation of new recessed can lights.
Occupancy: R-2 Type Construction: VA Valuation: $6,500.00
,x................,,_...........,.....,......«......,.,................,.,......., FEE SUMMARY ......,.,.,..�..,..,.,,.....,,.,............,,,,.....,,,.........,>.................
Building Permit-----------> $139.25 Bldg Plan Check----------> $90.51 Use Tax Fee-----------------------> $0.00
Electrical Permit---------> $172.50 Elec Plan Check-----------> $112.13 Restuarant Plan Review--------> $0.00
Mechanical Permit------> $0.00 Mech Plan Check---------> $0.00 Additional Fees--------------------> $0.00
Plumbing Permit--------> $0.00 Plmb Plan Check---------> $0.00 Recreation Fee--------------------> $0.00
Investigation-----------------------> $0.00
W ill Call------------------------------> $10.00
� TOTAL PERMIT FEES--------------> $524.39
Payments-------------------------------> $524.39
BALANCE DUE------------------------> $0.00
.»....................x......,........,..........,,........,....,,.................,.......,........«...........,.......x.,,.................,.,,.x.........,,...«._...................
DECLARATIONS
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 approved, International Building and Residential Codes and
other ordinances of the Town applicable thereto.
REQUESTS FOR INSPECTION SHALL BE MADE TWENTY-FOUR HOURS IN ADVANCE BY TELEPHONE AT 970.479.2149
OR AT OUR OFFICE FROM 8:00 AM -4:00 PM.
combination permit_012811
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.....�.................,........�....,..,x,................,,,...,.,,..,......,,........,....,x...................�.,.,...........,...�.,.........�.........,.,........,.,.,.,........
CONDITIONS OF APPROVAL TO BE MET PRIOR TO FINAL SIGN OFF
� Permit#: 613-0127 Address: 595 VAIL VALLEY DR VAIL
Owner: RYBOK X LLC Location: Manor Vail
Unit 227
.,.........,�........................................................................»....,.......,...........,.............»....,............,�.,,,.........,,.x,.............,,x...
combination permit_012811
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TO�UN(�F YA;fL .
*************,.*******.x,***********..****..*,*,�*..***************W**************..*****w*****************,**************************..*********,******��
REQUIRED INSPECTIONS AND STATUSES
�
Permit#: B13-0127 Address: 595 VAIL VALLEY DR VAIL
Owner: RYBOK X LLC Location: Manor Vail
Unit 227
******************«********«««*«*«*,.,.***�*,.********.,««««*«******************««*.,.«**************,.*«*******«***********«************«***,.,.************
Item: 00120 ELEC-Rough
Item: 00030 BLDG-Framing
item: 00050 BLDG-Insulation
Item: 00060 BLDG-Sheetrock Nail
Item: 00190 ELEC-Final
Item: 00090 BLDG-Final
combination permit_012811
�
***********************************+++***+**********+***************************************
TOWN OF VAIL, COLORADOCopy Reprinted on 05-13-2013 at 11:42:56 OS/13/2013
Statement
****************************************************************************************�***
Statement Number: R130000565 Amount: $321.75 05/13/201311: 42 AM
Payment Method:Credit Crd Init: CG
Notation: visa austin
thomas
-----------------------------------------------------------------------------
Permit No: B13-0127 Type: COMBINATION BLDG PERMIT
Parcel No: 2101-081-0700-4
Site Address: 595 VAIL VALLEY DR VAIL
Location: Manor Vail Unit 227
Total Fees: $524 .39
This Payment: 5321.75 Total ALL Pmts: $524 .39
Balance: $0.00
*****************************************************�**************************************
ACCOUNT ITEM LIST:
Account Code Description Current Pmts
-------------------- ------------------------------ ------------
BP 00100003111100 BUILDING PERMIT FEES 139.25
EP 00100003111100 ELECTRICAL PERMIT FEES 172.50
WC 00100003112800 WILL CALL INSPECTION FEE 10.00
-----------------------------------------------------------------------------
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PROPOSED NEW 30X80
DOOR TO MATCH THE STYLE
C1F T4-IF (1THFR IIC�(�R�
27'-0"
����n�n ofi Vail
3EVIEWE� �r�� ��
�OMPL���;
�ate:...�._ J�
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b r.,,�:
-�- �3
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National Gypsuro CoMpany
G�psum Wdlboad Floa/Ceiina—Mbod Franin9�wood lasts with ra�and finished floor)
1Ps
No. Fro Rating Ref. De�gn Na Desaqtion STC Test No. IIC
su+a.E ur� �o c.� �a tw
I hr. UL L501 5/B"(15.9mm)Fie-9idd Gpam�ovd a 5/8' 37 Bas�d m � 66
GA FC 5420 (15.9mm)FS Solfit Bo�d nd attodied to 2 Y 10 ��4
(3Bmm x 241mmrrood jabts spoad 16'ac.
(106mm�u d�igi L501 perrtwis aptim d Floa
iappnq Mistue ova plyrood
WOOD JOISTS.GYPSUM WALLBOARD,RESILIENT CHANNELS
)ne layei s�i"prop�iMary type X pypaum welkward oi gypsum vuneer besc 2ppfiad ut�ight
angtes to rer.;iliem lurcing ch:�unels 16"o.c,wAh t"Type 5�Mywall screws 1't"o.c.
4ypsum boeid end joinls bcrded rtddway betv.�een continuous channels and attached to
addilional piec�s ol channel 72"long wilh screws 8"o c.Resiliant tuving channels
applred at�ighl angles to 2 x 70 wood"pisls 24"o.c,wdh 6d coatad naAS,1��e"Wng.
0.092'shank,�;i heads.Wood pists supp�rt�ng sA"rwminal interior plywood wilh
exterbr gluo T 8 G subfloor peipendicu�r to loists with joints staggered,Und�:rsida oi
T 8 C;joiiris covered between luist spacas wflh 6'x 22�/z"x 5/i type X gypsum walBwerd
t�etlens atlacAod to flooring with 16 gege x 1�r."legs z��i crown staples spacr.A 7"o.c.
abng each edge.
PROPRIETARY GYPSUM BOAflD
\inerican Gypsum Company � ?'c"FIREBLOC TYPE C
3PB Arr�etica Inc. - gii ProRoc*"'fypa G Gypsum Paneis
i-P Gypsum - 6M loughRock"'Fireyue�d^C
afarge North Amaiica loc. - s�i Fkecheck��Type C
J�ational Gypsum Cortpany - ?9"Gold Bond�Biar�d FIRF-SHIFID CTM
Gypsum Walboard
�ABCO G�[18lIRi - b/I FLAME CURB�^tiuper'C'
�emple-Inland foresl Products Goryaetion - s�s'T6-C
lni�ed S�ates Gypsum Company � Sh"SHEETIiOCK��Arand Gypsum
Pnnela HR[CODE'`C Co�e
Unit 227 PLAN
IVU I t5:
1. COORDINATE LOCATION OF RECESSED CAN
LIGHTING WITH EXISTING STRUCTURE. USE RATED
CAN LIGHTING, FIRE-TAPED 5/8"G.W.B. ENCLOSURES,
OR TENMAT RATED LIGHTING ENCLOSURE.
MAINTAIN THE EXISTING 1 HOUR RATED UNIT
SEPARATION.
LEGEND: 2, GENERAL CONTRACTOR TO MEET 2012 IRC REQUIREMENT
� FIRE SPRINKLER(EXISTING) SECTION N1104.1 LIGHTING EQUIPMENT:
Q SMOKE DETECTOR(EXISTING) A MINIMUM OF 75 PERCENT OF THE LAMPS IN
PERMANENTLY INSTALLED LIGHTING FIXTURES SHALL
(��� RECESSED CAN LIGHT FIXTURE(NEW) BE HIGH-EFFICACY LAMPS.
�,� RECESSED CAN LIGHT FIXTURE(EXISTING)
,, . �
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AFWrox.Ceiling
Weight: 2.5 pd
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TOWN OF VAIL, COLORADO Statement
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Statement Number: R130000936 Amount: $202. 64 04/29/201302:09 PM
Payment Method:Credit Crd Init: LC
Notation: CREDIT CARD
FROM AUSTIN THOMAS, HIGH MOUNTAIN HOMES INC
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Permit No: B13-0127 Type: COMBINATION BLDG PERMIT
Parcel No: 2101-081-0700-9
Site Address: 595 VAIL VALLEY DR VAIL
Location: Manor Vail Unit 227
Total Fees: $524 .39
This Payment: $202. 64 Total ALL Pmts: $202. 64
Balance: $321.75
********************��***********ss********�*****�*******�*****���******�****r********r���**
ACCOUNT ITEM LIST:
Account Code Description Current Pmts
-------------------- ------------------------------ ------------
PF 00100003112300 PLAN CHECK FEES 202. 64
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D � � � � v � epartment of Community Development
75 South Frontage Road
TOWN QF VAIL� A� 2 9 2013 vai�, CO 81657
Te1: 970-479-2128
Cwww.vailgov.com
TOW OF VAIL Development Review Coordinator
BUILDING PERMIT APPLICATION
(Separate applications are required for alarm &sprinkler)
Project Street Address: � � — i5(Q
Project#:
595 E.Vail Valley Drive
(Number) (Street) (Suite# DRB#:
Building/Complex Name: Manor Vail Lodge Unit 227
) Building Permit#: ��� � ���—
Contractor Information Lot#: Block# Subdivision:
Business Name: High Mountain Homes, Inc.
Business Address: PO Box 477 Work Class: New(�) Addition(Q) Alteration (Q)
City Eagle State: CO Zip: 81631 Type of Building:
Austin Thomas Single-Family(�) Duplex(�j Multi-Family(Q)
Contact Name: Commercial(� Other(Q)
Contact Phone: 970-376-5475
Contact E-Mail: austin81631 @gmail.com Work Type: Interior(�) Exterior(Q Both(�
I hereby acknowledge that I have read this application,filled out Valuation of
in full the information required,completed an accurate plot plan, Work Included Plans Included Work
and state that all the information as required is correct. I agree to ,Electrical (�'es (�No (Q`(es (�l0 1500
comply with the information and plot plan,to comply with all Town
ordinances and state laws, and to build this structure according to Mechanical (�Yes �No �Yes (QNo
the town's zoning and subdivision codes, design review ap-
proved,International Building and Residential Codes and other Plumbing �Yes �No �Yes �No
ordinanc f the Town applicable thereto. 5000
Building (�i Yes �No (�Yes QNo
X Value of all work being performed: $ 6500
Owner/Owner's Representative Signature(Required) ',(value based on IBC Section 109.3 81RC Section 108.3�
Electrical Square Footage 1500(whole unit)
Applicant Information Detailed Scope and Location of Work: Construction of
Applicant Name: Austin Thomas interior wall to create additional bedroom. Installation of
Applicant Phone: 970-376-5475 new recessed can lights.
Applicant E-Mail: austin81631@gmail.com
Project Information Rybok X LLC- Kevin Maher
Owner Name:
Parcel#: 2101-081-07-004
(For Parcel#,contact Eagle County Assessors Office at(970328-8640 or visit
www.eaglecounty.uslpatie)
- (use additional sheet if necessary)
For Office Use Only�ao a - b� Date Received:
Fee Paid:
Received From:
Cash Check#
CC: Visa/MC Last 4 CC# exp date:
Auth #
2013-Feb 01