HomeMy WebLinkAboutB13-0395 CR1 TRANSMITTAL.pdf Department of Community Development
kT
75 South Frontage Road
TOWN OF UAIL ' Vail, CO 81657
Tel: 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 reissuance of the permit.
Application/Permit#(s)information applies
to: Attention: (D Revisions
esponse to Correction Letter
.Q attached copy of correction letter
C)Deferred Submittal
Other
Project Street Address:
1,51 Ufa U �+ }-
(Number) (Street) (Suite#)
Building/Complex Name:_ �, f: k4k Description of Transmittal/List of Changes, Items Attached
CLAL Vc c ' �14 w-�d .S
Applicant Information
(architect,contractor,owner/owner's rep)
Contact Name �2iR
Address
City �1 State: Zip
Contact Name: �51!L C— JJ (use additional sheet if necessary)
f
Contact Phone: lu '� 5 Building Permits:
n�, Revised ADDITIONAL Valuations(Labor& Materials)
Contact E-Mall: t! (DO NOT include original valuation)
I hereby acknowledge that I have read this application, tilled 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, International Building and Residential Codes and other Mechanical: $
ordinanS of the Town applicable thereto
Total. $0 t
Owner/Owner's Rep sentative Signature(Required)
Date'Received:
For Office t se Only
Fee Paid:
Received From:
Cash Check# _
CC: Visa f MC Last 4 CC exp.date:
Authorization #