HomeMy WebLinkAboutB13-0154 APPLICATION.pdf Department of Community Development
01 75 South Frontage Road
TOXIN OF V►41rI.' Vail, CO 81657
Tel: 970-4792120
www.vailgov.com
Development Review Coordinator
BUILDING PERMIT APPLICATION
(Separate applications are required for alarm &sprinkler)
Project Street Address: Project#
r.� V�1 • a8so Pry 0-1
DRB#
(Number) (Street) (Suite#)
Building/Complex Name: Building Permit#:�[x1���S
Contractor Information ,' Lot#: Block# Subdivision:
Business Name: � ��1�11'l� '
J� p Work Class: New Addition Alteration
Business Address —?o
City VAN�_ State: 0 Zip: L3�\UE&p Type of Building:
Single-Family() Duplex( Multi-Family
Contact Name:
CommeraM 0 Other 0
Contact Phone: � � ��
Contact E-Mail: (jam) Work Type: Interior IT�l Exterior() 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 ()Yes �No Yes ONo
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 ONo OYes 0No
the town's zoning and subdivision codes,design review ap-
proved,International Building and Residential Codes and other Plumbing Yes ONo Yes ()No 115()d
ordinances of the Town applicable thereto.
V Building /( Yes 0 N }Yes ONo _11600 A Value of all work being performed: $ C
Owner/Owner's Re a entative Signature(Required) (value based on I®c Section 109 a a IRC Section 10B.3)
Electrical Square Footage
Applicant Information i_ Detailed Scope and Location of Work: f
Applicant Name: �tY � ' 1 y�Y - pir] Tp f r7ejLJc
Applicant Phone: _kk1:,
Applicant E-Mail
Project Information &C-
Owner Name: .l &C-
Owner
Parcel#: �i �`
(For Parcel A contact Eagle county Assesso ce at(870-328-8640 or visit
www.eag I ec ountyruslpat ie)
(use additional sheet if necessary)
For Office V.w Only:
[]Iatr: Received:
Fee Paid:
Received From:
Cash Check #
CC: Visa/ MC Last 4 CC# exp date:
Auth #
12-Mar--1012