HomeMy WebLinkAboutB13-0117 transmittal Department of Community Development
75 South Frontage Road
TOWN OF VAIL � Y -- va�i, co s�ss7
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.
Application/Permit#(s)information applies
to: ttention: ( )Revisions
a ,� � -�� `/� n__� /�/)�� �) Response to Correction Letter
i /( 7 ..1 ��s ' «7����6�'�"�> attached copy of correction letter
( )Deferred Submittal
( )Other
Project reet Addres :
�3�� -.��s�� �� �I�
,(Number) (Street) (Suite#)
Building/Complex Name: ����� C�i�'� � Description of Transmittal/List of Changes, Items Attached: '
Applicant Information �� �1� c%° i�.��' '�L�',/" " '
(architect,contractor,owner/owner's rep)
'Contact Name: !� OI�I���J r` ( � �'T' `" - L
Address: �� x 5 s �
1 �
City L- State:C J zip: /�' � `
Contact Name: �t�' �" � ' `"`''�"" � i;(use additional sheet if necessary)
� 3 � . , 9 , ., . , .
Contact Phone: � Ct�/'� Buildin Permits:
-,� �'
�� �L r��'�G�-��G��� ���„�evised ADDITIONAL Valuations(Labor&Materials) '
Contact E-Mail: � � - (DO NOT include original valuation)
I hereby acknowledge that I have read this application,filled out ;Building: $ /��
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 laws, and to build this structure according ,Electrical: $
to the town' oning n bdivision codes, design review ap- ',
proved, n i a tt�i g and Residential Codes and other :Mechanical: $
ordin s o plicable thereto. '
'X ' I Total: $
',Owner! wner's Representative Signature(Required) - - - - - - - '
' Date Received:
�_,.
For Oflice Use Only: �`��' � � ��, � �J
Fee Paid: ��
Received From: � �i MAY � 7 ��`��
Cash Check# �
CC: Visa/MC Last 4 CC# exp.date: '�' �
A�tn# TpWN OF VAIL