HomeMy WebLinkAboutB14-0033 REV4 transmittal Department of Community Development
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75 South Frontage Road
T�WN OF UAIL ' � van, CO 81657
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 applies
to: � Attention: ,�"t�evisions
��- �/ J y-���� �� �Response to Correction Letter
���t" ( / �attached copy of correction letter
� � ����� � Q Deferred Submittal
1' � � 1 �Other
_ . _ _.._ __ _..
Project Street Address:
��? I� � � - � �'�1,��
(Number) (Street) (Suite#)
BuildinglComplex Name: Description of Transmittal/List of Changes, Items Attached:
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Applicant Information
(architect,contractor,owner/owner's rep)
Contact Name:__���_"°'� ���,(� , �
, �� T .� � `��
Address:� � � ,� �—
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City���,1� State: �Zip:
Contact Name: (use additional sheet if necessary)
Contact Phone: �l�L7 -r Building Permits:
evised ADDITIONAL Valuations(Labor&Materials)
Contact E-Mail; (DO NOT inciude original valuation)
I hereby acknowledge t t I have read this application,filied 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: $
ordina e own applicable thereto. G9L�
X Total: $0
Ow r wner's Repres ative Signature(Required)
_ Date Received:
C� C [� � �% C� �
For Office Use Only: D
Fee Paid:
Received From: ��C 1 5 ZO�� �
Cash Check# I
CC: Visa/MC Last 4 CC# exp.date: p,
Authorization# ���� �� �#y�m���
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TOWN OF VAIL, COLORADOCopy Reprinted on 12-26-2014 at 08:55:43 12/26/2014
Statement
********+****+*******�***************************�*******************++*********************
Statement Number: R140002116 Amount: $125. 68 12/26/201408 : 55 AM
Payment Method: Check Init: CG
Notation: ck 1711
Ferguson Residence Remodel
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Permit No: B14-0033 Type: COMBINATION BLDG PERMIT
Parcel No: 2103-124-0300-1
Site Address: 1250 WESTHAVEN CR VAIL
Location:
Total Fees: $21, 683.79
This Payment: $125. 68 Total ALL Pmts: $21, 683.79
Balance: $0.00
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ACCOUNT ITEM LIST:
Account Code Description Current Pmts
-------------------- ------------------------------ ------------
BP 00100003111100 BUILDING PERMIT FEES 9. 50
PF 00100003112300 PLAN CHECK FEES 116. 18
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