HomeMy WebLinkAboutB12-0245 transmittal Department of Community Development
75 South Frontage Road
TOWN QF VAIL � vai�, co s�ss7
Te I: 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 reis:.�ance of ti�e permit.
Application/Permit#(s)information applies
to: Attention: Q Revisions
�n �Response to Correction Letter
�� (� ' � �attached copy of correction letter
;� Q Deferred Submittal
�� �=' �� ,, (�Other
Project Stree�ddress: ,� '
����fi��r�'�� �z�'�
(Number) (Street) (Suite#)
Building/Complex Name: iti' � � !��-'1�G� ; Description of Transmittal/List of Changes, Items Attached:
Applicant Information ��!/��rt/�LJLf�Lf'.�;�i ��J�IJ�'l/
(architect,contract ,owner/owner's rep)
Contact Name: /�GFI���'�i_!9?�c��
Address: y�/L�X _,,,�1���
City �/�l( State:�Zip: � � _ �
Contact Name: ;;(use additional sheet if necessary)
Contact Phone: .3y�� �V�,�� Building Permits:
� Revised ADDITIONAL Valuations(Labor 8�Materials)
Contact E-Mail:s�� '„/rjOG>>y6��2 � �c�,�'• �G}� '(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's zoning and subdivision codes, design review ap- ' !
proved, Intemational Building and Residential Codes and other Mechanical: $
ordinan of the own pplicable thereto.
X �/'�CIe�C���G�L�jyj Total: $� ,
� �
Owner/Owner's Representative Signature(Required)
Date Received:
� � � ^���/ �
For OTfice Use Only: D
Fee Paid: J�� U `f ��'��
Received From:
Cash Check#
CC: Visa/MC Last 4 CC# exp.date: 'T'OW� Q� V/'1IL.
Authorization#