HomeMy WebLinkAboutB13-0346 Application.pdf Department of Community Development
OT 75 South Frontage Road
TOWN OF VAIL 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#:
915 Red Sandstone 11D
DRB#:
(Number) (Street) (Suite#)
Building/Complex Name:
SandStone 70 Building Permit#:
Contractor Information Lot#: Block# Subdivision:
Business Name: Chimney Sweeps of America
Business Address:
565 E. 70th Ave. Suite W-2 Work Class: New(0) Addition (®) Alteration (E))
City Denver State: CO Zip: 80229 Type of Building:
yp
Contact Name:
Jon Geypens Single-Family(0) Duplex( ) Multi-Family(&
Commercial (0 Other(®)
Contact Phone: 720-940-6721
Contact E-Mail: jon @chimneysweepsofamerica.com Work Type: Interior(D) Exterior(0 Both (0
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 (kj'es (eNo (®Yes (IFINo
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 (®No $4170.00
the town's zoning and subdivision codes, design review ap-
proved, International Building and Residential Codes and other Plumbing (0Yes e)No ()Yes �No
ordinances of the Town applicable thereto.
Building (®Yes 0i No ( Yes No
X Value of all work being performed: $ 4170
Owner/Owner's Representative Signature(Required) (value based on IBC Section 109.3&IRC Section 108.3)
Electrical Square Footage N/A
Applicant Information Detailed Scope and Location of Work: Fireplace located in
Applicant Name: Jon Geypens Sandstone 70 11 D
Applicant Phone: 720-940-6721
Applicant E-Mail: Jon @chimneysweepsofamerica.com
Project Information Jon Geypens
Owner Name:
Parcel#: 210301401036
(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: Date Received:
Fee Paid:
Received From:
Cash Check#
CC: Visa/ MC Last 4 CC # exp date:
Auth #
2013-Feb 01