HomeMy WebLinkAboutB13-0515 CR1 transmittal .
Department of Community Development
75 South Frontage Road
TOWN OF UAIl. � vai�, co s�ss7
Tel: 970.479.2128
www.vaiigov.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.
ApplicationlPermit#(s) information applies
to: Attention: ( ) Rev' ions
��(� `-O S� � C� - esponse to Correction Letter
attached copy of correction letter
�l �t � '�`C C� ( ) Otherred Submittal
Project Street Address: -7
�_ T I N�N l �f hfN 1�- � � �—L �
(Number) (Street) (Suite#)
Building/Complex Name: �1������'�� ��'�� Description of TransmittaU List of Changes, Items Attached:
_ `�Z,�S
Applicant,Information '
(architect, contractor,owner/owner's rep)
Contact Name: �� l� ('��U-- [ v 9�1 1
:Address:
City State: Zip:
ContaCt Name: (use additional sheet if necessary)
Contact Phone: Building Permits:
Revised ADDITIONAL Valuations (Labor&Materials)
Contact E-MaiL (DO NOT include original valuation)
I hereby acknowledge that 1 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 Town applicable thereto. �
X ,� ',/: � Total: $
� sf
wne.r/Own R�pk8s�ntative Signature(Required)
'�'J, � r Date Received:
� � � � V �
For Office Use Only: D
Fee Paid: �A� �. 1 ZQ�4
Received From:
Cash Check#
CC: Visa/MC Last 4 CC# exp.date: TOV`IN OF VAI L
Authorization #