HomeMy WebLinkAboutB13-0380 APPLICATION.pdf Department of Community Development
75 South Frontage Road
TOWN OF VAIN 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:
I)q 3 o rU ll / V trye ice✓ /,� Project#:
(Number) (Street) I (Suite DRB#:
- #)
Building/Complex Name: ► I+1L Iv\ ca t4 -I..,) Q.,Me5 Building Permit#:
Contractor Information Lot#: Block# Subdivision:
Business Name: 06of-f Cd.("t D,s1 d
Business Address: 000-9 1645+ f3cc ✓Ql- cle f y. g hid , Work Class: New 0 Addition(0 Alteration(8
City A✓0.1 State: L o Zip: O Type of Building:
�2 1 1 Single-Family I0 Duplex a Multi-Family(0
Contact Name: JIT SO K\ t/Js�, t l
Commercial� Other
Contact Phone: � 7 d .� �7,6, yb o o 1
Contact E-Mail: 1��S G E'I ►�a� (��''�dg C- d�1 a✓ C 0 IM Work Type: Interior 0 Exterior 0 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 Q)No QYes ONo
j
comply with the information and plot plan, to comply with all Town
ordinances and state laws, and to build this structure according to Mechanical QYes Q)N QYes ONo
proved,town's zoning and subdivision codes, design review ap-
proved, International Building and Resid t ntial Codes and other Plumbing Yes ONo QYes GNo C��
ordinance of the Town applicable ther o.
Building QYes QNo QYes ONo q �
X �'6 Value of all work being performed: $ 1 J� r 06
Owner/Own is Representative Signature(Required) (value based on IBC Section 109.3&IRC Section 108.3)
Electrical Square Footage J
Applicant Information Detailed Scope and Location of Work: Ne bi �-At)I
Applicant Name: Govt- ',r cf JVt IVl r�/�r��e I/1 ✓�E'(� !� I�C�C'✓� 15 �C�VICKI, ��O I/P
Applicant Phone: 01 7 0 1`"1 0 1 1 J � g,I fG�PV1 S I yl A (e V)JU,f'B S I✓1� �Vl DC)1,J e,(
ApplicantE-Mail: ;(� Svin f� CioI'I �1qC�J}ti CU,n1 (66i/� IG1Ce l I � � lei C�-
Project Information/ - //� 1� a lace S�1GIn)�✓ ( w 0ZCt5 f.cr y�t'cl (rjo�/!
Owner Name: L� ✓�7 <"f V>d e � 01'1
r^e,Place (Joscf In 0vks�e,
Parcel#: 6 f 0 �� i s
(For Parcel#,contact Eagle County Assessors Office at(970-328-8640 or visit
www.eag I ecou nty.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 #
12-Mar-2012