HomeMy WebLinkAboutB14-0265 REV1 transmittal Department of Community Development
75 South Frontage Road
TO W!V 0 F VA I L vai�,co s�ss�
Tel: 970.479.2128
www.vaitgov.com
Development Review Coardinator
TRANSMlTTAL FORM
Use this form when submitting additional information for pianning applications or buitding 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)�nformation applies
to: Attention: Di Revisions
B-140265 �Response to Carredion Letter
attached capy af correction letter
�Deferred Submittal
�Other
Pra'ect Street Address:
17�67 Apline Dr East
(Number) {Street) (Suite#)
Building/Complex Name: Description of Transmittal/List of Cha�ges, Items Attached:
Replace stair well
Applicant Infortnation Refinish bathrooms
(architect,contractor,owner/owner's rep)
Contact Name: Mcltt BOt71@C
Address: PO BOX 273
C ity
V1i! state: �O Z�p: 81658
contact i�ame: Matt Bomer
(use addftional sheet if necessary)
Contact Phone: g7Q�sg8-�$72
Building Pern►its:
Contact E-MaiL ma�[@CCCVa1LCOtl't Revised ADDITIONAL Valuations(Labor 8 Materials)
(DO NOT include original valuation)
I hereby acknowledge that I have read this application,filied out Building: $ j 3'���
in full the information required,completed an accurate plo#plan, 50�0
and state that all the information as required is corr�t_ I agree to p►�mbing: $
comply with the information and plot plan,to comply with all Town 48�0
ardinances and state laws, and to build this structure according Electrical: $
to the town's zoning and subdivision codes, design rev'sew ap- 4200
proved,Int ation Building and Residential Codes and other Mechanical: $
ordinanc of t own applicable 27,$00
X . Totai: $
Owner/Owner's Representative Signature(Required)
Date Received:
For Office LEse Unly:
Fee Paid:
Received From:
Cash Check#
CC: Visa/MC Last 4 CC# exp.date:
Authorizadon#