HomeMy WebLinkAboutB13-0417 REV4 transmittal �
Departmen[of Community Developmen[
75 South Fron[age Road
iOWN OF VAIL ` Vail, CO 81657
Tel: 970.479.2128
www.vailgov.com
Developmen[Review Coortlinator
TRANSMITTAL FORM
Use ihis form when submitting atltlitional information for planning applicatians or building permits.
This form is also used for requesting a revision to builtling permits. A iwo hour minimum buildin9 review
fee of$110 will be chargetl upon reissuance of the permit.
Application/Permil#�s)informationapplies �� �
to: AHention: (�Revisions
� / J _�� y�' -7 o Response to Correction Letler
� �attachetl copy of conection letter
\ ,� �� �._����� �{�—��_��� �Deferred5ubmitlal
� �V °J l�Other
Project Street Adtlresr. � � �
j_Y1 L' . :7u41n... �r .
�Number) �Streeq (Suitett)
Bullding/Complex Name: Description of Transmittal/List of C�anges, Items Attached:
. . . . H.{ct: fie.�..< L'�lwYr;�..f �
Applicant Information
IhLt�Anlca�.l wO.-� i-a L'�=:5'i. .
(architect, conVactoq owner/owneYS rep)
Contact Name
. �$f'F�� LJJV>�.lt'S.S �-d.�nn..n:c�+so,-.:_ �l �.Li .
Address'. � � Z�/' W' ��'�+JY-� ��,�I� . I�
City 'AP `'�� State:�Zip: N���"I
��Contact Name'. �i N^ ��.DUyp'y (use additional s�ee�if necessary)
ContactPhone: Z�(� '9 � �� l��� BuildingPermits:
� �;1 A _ ���,1�� crY 'J� RevisedADDITIONALValuations(Labor&Materials)
Contact 6Mail ��^+�C NS i I'�-A�� (DO NOT include original valuation)
I hereby acknowledge lhat I have read�his applicatioq filletl out Builtling'. $
in fu0�he informalion required,completed an accurate plot plan,
and scate ihat all Ihe information as requiretl is correct. I agree to Plumbing'. $
compty with the information and plot plaq fo comply with all Town
ortlinanws and state laws, and to builtl ihis stmcture accortling ElectricaC $ � �° �
to lhe town's zoning and subdivision cotles. tlesign review ap-
prov , temational Building and ResidentialCOtles antl other Mechanical' $ �-. 5 V`�
ortli nc oRhe�licabl ret � � �� �
X Total' $
OwnedOw f Representative Slgnature(Required)
�ate Received:
For Oliice Cu Only.
Fee Paitl:
Received From:
Cash CM1eck#
CO Vlsa/MC LaR 9 CC N exp.tlale:
Authorization F