HomeMy WebLinkAboutB13-0166 APPLICATION.pdf Department of Community Development
75 South Frontage Road
TOWN OF VA 11[ Vail, CO 81657
Tel: 970-479-2128
www.vailgov.com
Development Review Coordinator
BUILDING PERMIT APPLICATION
(Separate applications are required for alarm& sprinkler)
Project Street Address: Project#:
170 PGfafo wok p(tvt -4 g
(Number) (Street) DRB#:
.t �/ (Suite#)
Building/Complex Name: /G PGfOL� YOtIt.I� Building Permit#:
Contractor Information Lot#:_Block# Subdivision:
Business Name: cot' f-octoyiP�e
Business Address: 6014? Ea- IJl'6�✓Q�'GlQe k f��✓d• Work Class: New Addition 0) Alteration�)
City / yor, State: C,0 Zip: ,9 0 Type of Building: aliN
Contact Name: �
�c0 h f tl t/SSC I Single-Family D Duplex(4W Multi-Family
Commercial() Other 0)
Contact Phone: q 70 6 76 . g61.b r�f
Contact E-Mail: Jasoinr@(,,o4,,;iAc f onf,C QeM Work Type: Interior) Exterior 0 Both 0
d
1 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 �)No J ®• 00
comply with the information and plot plan, to comply with all Town
ordinances and state laws, and to build this structure according to Mechanical DYes ®)No )Yes QjNo I
the town's zoning and subdivision codes, design review ap- c�
proved, International Building and Residential Codes and other Plumbing jYes Q)No OYes C)No
ordinances of the Town applicable thereto. U ®)No q75-0,
Building Yes®
X i( Value of all work being performed: $
Ow4rwner's Representative Signature(Required) (value based on IBC Section 109.3&IRC Section 108.3)
Electrical Square Footage y5
Applicant Information Detailed Scope and Location of Work:
Applicant Name: ,Or^VI'-,?,r t d►1P ftdd(rA �00AA tat!$ C�0$e,�S 04'1 �O
Applicant Phone: q'G I M bed to owl S
Applicant E-Mail:JrA A f2 con kra c A&e C 6M �` {etMGp�F ll A
Project Information `�~ I tk(o 0 r►A
Owner Name: 1 / G ►t t4G(@✓S®✓,
Parcel#: a(0 !0631900,J_
(For Parcel#,contact Eagle County Assessors Office at(970-328-8640 or visit
www.eaglecounty.us/patie)
(use additional sheet if necessary)
For Office Use Only:
Fee Paid: Date Received:
Received From:
Cash Check#
CC: Visa/ MC Last 4 CC# exp date:
Auth #
15-Mar-2012