HomeMy WebLinkAboutB14-0237 REV4 transmittal Department of Community Development
75 South Frontage Road
TOWN OF VAII� � ( va�i,co s�ss�
-, Te1: 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: Q Revisions
� i, � �.-7 �� � _ �Response to Correction Letter
� C Z-. i �attached copy of correction letter
(')��` �y ` � � � � y Q Deferred ubmitt I - -a _y�)1 .---�
�"� -r IQ'Other��1.i��� �' k �f�1�- I
Project Street Address:
1 I�S �� i' ,n►�'i =,:"t; �)
(Number) (Street) ,.�-- (Suite#)
(,�.r 5� w�� �
�
Building/Complex Name: t�C��1 J'�'�i,lN)CJk'1)bl�, �D I�t' Description of Transmittal/List of Changes, Items Attached:
Applicantlnformation ��G����� �� �UF ,
(architect, ontracto owner/owner's rep)
Contact Name:/11���� Z--
Address: ��� 5 S � � �3 /` l.'�^
City�f 1� /V lv/V State: �-C? Zip:��}F'� 2—,
3 - z� � -���s �
Contact Name: � (use additional sheet if necessary)
Contact Phone: � l `/�� � �'I`d�I" ���R�-� �, -� Building Permits:
Revised ADDITIONAL Valuations(Labor&Materials)
Contact E-Mail: (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, International Building and Residential Codes and other Mechanical: $
ordinances the Town applicable thereto.
X •'"� � j�,,�(t;1,- Total: $�
Owner/ ner's present e Signature (Required)
Date Received:
L�, � l_� .I� � �
For O�ce Use Only: D
Fee Paid: 1
Received From: ��� �. .1 ��14
Cash Check#
CC: Visa/MC Last 4 CC# exp.date:
Authorization# TOWN OF VAaL