HomeMy WebLinkAboutB13-0320 REV1 transmittal Department of Community Development
75 South Frontage Road
TQWN OF VA(L � •� va�i, co s�ss7
Tel: 970.479.2128
www.vailgov.com
Development Review Coordinator
TRANSMITTAL FORM
Use this form when submitting additionai 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: (�}Revisions
�� j� _ � �� � � � ( ) Response to Correction Letter
/ r I attached copy of correction letter
--> ( ) Deferred Submittal
�� � I �� ` � �� .� ( ) Other
Project Street Address:
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(Number) (Street) (Suite#j
Building/Complex Name: Description of Transmittal/List of Changes, Items Attached:
. � 1°�G��`S vv/ sTi'�UcTU/2�9L
Applicant Information
� � ����/t��sl Cl� �5.� C�itn�x ��
(architect, contractor,ownerlowner's rep) �.�
Contact Name: �Z� ��/U . S/���"�'� ����:�
GO ,
Address: �{���t:� �{
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City �t�F -1/�-lrt- State: C � Zip: �%�� 'z
Contact Name: Si°�7N1 E (use additional sheet if necessary)
Contact Phone: (�d 1 3�� „� �7� Building Permits:
Revised ADDITIONAL Valuations (Labor&Materials)
Contact E-Mail: Q���. �S�'�,�(�!� � �.e3�'1') • (DO NOT include original valuation)
I hereby acknowledge that I have read this application,filled 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: $
ordinances of the own applicable thereto. ____..
X �'�� � ����(/� -'� Total: $ .
Owner/Owner's Representative Signature(Required)
Date Received:
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For Office Use Only: D
Fee Paid: �'��"j' � � ����
Received From:
Cash Check#
CC: Visa/MC Last 4 CC# exp.date: TOWI�I OF VAIL
Authorization #