HomeMy WebLinkAboutB13-0394 APPLICATION.pdf Department of Community Development
75 South Frontage Road
TOWN OF VA I t_ 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#:
L1 G J l7RB V 1 Ll
(Number) (Street) (Suite#) #: �i ( l
BuildinglComplex Name: 1 1 y'� ]�(,} Building Permit#:
Contractor Information ; 1 Lot#: Block# Subdivision:
Business Name_
Business Address: ] Work Class: New 0 Addition Alteration{
City State: dip.
Type of Building:
` Single-Family() duplex 0 Multi-Family
Contact Name: T[1 ///�Y
Commercial(0 Other{0}
Contact Phone: e3 I U C7)=:1('
Contact E-Mail: ]� 1 co— Rx 1 , 1 ) Fork Type: Interior 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 `{es N'0 Yes ON- loo)
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 (Q)No ij Yes No
the town's zoning and subdivision codes,design review ap- 7�
proved,International Building and Residential Codes and other Plumbing Yes ONO Mes ()No U
ordinances f the Town applicable thereto.
} Building (k�Yes ONO Yes oNo zz �
X '`" Value of all work being performed $ J�qw, }
Owner/Owner's RepreseiUative Signature(Required) (value based on IBC Section 1093 8 IRC Section 108.3)
Electrical Square Footage
Applicant Information Detailed Scope and Location of Work:
Applicant Name: I lt_n r
Applicant Phone: '} Q ('( � -- vN ?�
Applicant E-Mail:
Project information ��{{
Owner Name: r
Parcel#: 9,1 Ci l i� Z
i1=or Parcel 4,contact Eagle County Assessors office at(970.328.8640 or visit
www.eaglecounty.uslpatie)
(use additional sheet if necessary)
For OMce 1Ise Only:
Date Received:
Fee Paid:
Received From:
Cash Check#
CC: Visa 1 MC Last 4 CC# exp date:
Auth #
12-Mar-2012