HomeMy WebLinkAboutB12-0401 REV2 transmittal Department of Community Development
75 South Frontage Road
T�W� �F UA��. � Tel: 970.409 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�:f th . permit.
Application/Permit#(s) information applies
to: Attention: �Revisions
� � ( ) Response to Correction Letter
'y �d�0 J ���� - �'j,��/,,�s"� ��� attached copy of correction letter
� ( ) Deferred Submittal
� �� —�(J �� ( )Other
Pro ect Street Add�r,ess: a
�s� ��ii��� �����'o�_
(Number) (Street) (Suite#)
Building/Complex Name: Description of TransmittaU List of Changes, Items Attached:
/ ��/.��� .-�,�s,�J -
Applicant_Information
(architect, contractor�ner/owne�r's rep)
,� ' c-� v;%��
Contact Name: ���' � � �
Address: �� �� 7� �
City (.��`i� State: ��� Zip: ���-�
ContaCt Name: �/� �`� � (use additional sheet if necessary)
Contact Phone: ���""����� � f Building Permits:
� � Revised ADDITIONAL Valuations (Labor 8�Materials)
Contact E-Mail: ?_'�..-�� �� G''��`-���, �.�s'� ���`f� (DO NOT include original valuation)
I hereby acknowledge that I have read this application,filled out Building: �
in ful�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 Town appl' ble thereto.
X ��� �� Total: $
� i�
Owner/Owner's Representative Signature(Required)
Date Received:
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For Office Use Only: �j �s �� ��,s�� ,� � i I
Fee Paid: "
Received From: �►1����� �
Cash Check#
CC: Visa/MC Last 4 CC# exp.date:
Authorization # TQ��f�l �� �!A I L
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