HomeMy WebLinkAboutB13-0508 REV2 transmittal ��;= Department of Community Development
� 75 South Frontage Road
TOWN OF VAlL�'`��� va�i, co$�ss�
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 appties
to: Attention: �Revisions
�, I � , v��� �Response to Correction Letter
`� �attached copy of correction letter
Q Deferred Submittal
f�Other
Project Street Address:
�-� ����<�_}- ��
(Number) (Street) (Suite#)
Building/Complex Name: Description of Transmittal/List of Changes, Items Attached:
Applicant Information
� i�tiG�U �=� � I�Uv�tc��; ��<<:�'l
v�.�d�����-F,'��, s� p�t�w,�����7
(architect,contractor,owner/owner's rep) _
ContactName: V�� /'F''�t�-C�;��C:j1 ���"���� l
Address: �� V� ��U h �Ly I,� �� `.�l`�,`-� 5� PU ..r
, -� ,�� <�1��c� ru�,.'�t.�, 5�c-���� �
City ° " J I'1 State: Zip: ��
�
Contact Name: l ��i �'�/��Y�f�:�1
�' (use additional sheet if necessary)
Contact Phone: [ / � � � �v "` CJ`��G
Building Permits:
1 Revised ADDITIONAL Valuations(Labor&Materials)
Contact E-Mail:�;,�6;,��iG,;,;w�_,a t'�:.�sf����,C�� � <�=°'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, I terna i nal Building and Residential Codes and other Mechanical: $
ordina o Town applicable thereto.
X, 1 _ Total: $0
Owner/Owner's Representative Signature(Required)
Date Received:
For Of1ice Use Only:
Fee Paid:
Received From:
Cash Check#
CC: Visa/MC Last 4 CC# exp.date:
Authorization#