HomeMy WebLinkAboutB13-0293 REV1 Transmittal.pdf rukus floorage 3056470688 p.1
Department of Community Development
6� 75 South Frontage Road
TO WN OF U�� Tel:970.4779.2128
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 reissuanee of the permit.
ApplicationlPermit#(s) iniormation applies
to: Attention: Revisions
C� Response to Correction Letter
�)in7 =attached copy of correction letter
C)Deferred Submittal
IQ Other
If roject Stree ddress: r
42c
r
l�J � `fir�d���� _ � ;•
(Number) (Street) (Suite#) k
BuildinglComplex NarJDkt`�� 4 C`t � ) 01L41 C Description of Transmittal/List of Changes, items Attached:
1 �C�1 ill
Applicant Information J FC I's
(architect,contractor,,ownerlowner's rep)
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Contact Name: L- r -(,lip►'
Address:
state: zip: )
l Contact iVame: • 1 � �C (use additional sheet if necessary)
U Contact Phone: Building Permits:
evised ADDITIONAL Valuations(Labor&Materials)
Contact E-Mail: '?lUt ���i .i}ti ill l �L C`�� �E'�'!Lf� '�" dO NOT include original valuation}
I hereby acknowledge that l have read this application,filled out Building-. 5
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 lawn's zoning and subdivision codes, design review ap-
proved, International Building and Residential Codes and other Mechanical: $
o cVances of the Town pplicabl,r thereto.
Total: $o
Owner/Owner's R presentative Signature(Required)
Date Received:
For Office Use poly:
Fee Paid:
Received From:
Cash Check#
CC: Visa J MC Last 4 CC# exp.date:
Authorization