HomeMy WebLinkAbout12. B13-0034 REV5 transmittalDepartment of Community Development
75 South Frontage Road
T WN OF VA1l. vai, co s ss
Tei: 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: Revisions
b t i Response to Correction Letter
Y attached copy of correction letter
p '/I
Deferred Submittal
S i-1_7 `I V ( ) Other
Project Street Address:
rEJ El//'h-/' / f /
Number) (Street) Suite#)
Building/Complex Name:Description of Transmittal/List of Changes, Items Attached:
il/dc•d.li!'
Applicant_Information
architect, contractor,owner/owner's rep)
Contact Name:
Address: - G'
City State:Zip: /l S
Contact Name: -"+ /use additional sheet if necessary)
d v CJ 3ContactPhone: Building Permits:
Revised ADDITIONAL Valuations (Labor& Materials)
Contact E-Mail:o/' lJ 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: C,C7
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 nd s bdivision codes, design review ap-
proved, Internati i g e ' ential Codes and other Mechanical:
ordinances e a c re
X Total:
Owner/Ow er s Represent ve Signature(Required)
Date Received:
For Office Use Only:
Fee Paid:
Received From:
Cash Check#
CC: Visa/MC Last 4 CC# exp. date:
Authorization#