HomeMy WebLinkAboutB15-0220 REV1 transmittal °� �"��% Department ofi Community Development
� 75 South Frontage Road
���f� �� �'���.�' � vaa, co$�ss7
Tel: 970.479.2128
www.vailgov.com
Development Review Coordinator
TRANSM ITTAL FORM
Use this form when submitting additional information for planning appEications or buiiding permits.
This form is also used for requesting a revision to building permits. A two hour minimum buiiding review
fee of$110 wiil be charged upon reissuance of the permit.
'................................................
;Application/Permit#(s) information applies
to: Attention: �Revisions
�I � `6� , �� � �Response to Correction Letter
�attached copy of correction letter
P,Q � I � _�( �it� Q Deferred Submiftal
r�` LJ (�Other
...........................................................................................................................................................................................................................................................................................................:
__. _ .
Project Street Address: ��
�o�o �r� �� P��-C�
(Number) (Street) (Suite#) I,........._......................._..............................................................................................................................................,
' Building/Complex Name:�(��j� ���=� /i'���LfJS: Descriptian of TransmittaU List of Changes, Items Attached:
�
!:... ............_..............._............_................................................................................................................................... r �
;'Applicant Information /
;;(archifect,contractor,owner/owner's rep) ` ! J � Y
' = ��
' Contact Name_ �,� �� ����
Address: � �
r-- / � r � '
;City j�/� State: �C� Zip:
�
�Contact Name: I/�/���� �� G��z iJ�.k� `!(use additional sheet if necessary)
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;Contact Phone:_ ��' � �� � Building Permits:
� Revised ADDITIONAL Va[uations (Labor& Materials)
Contact E-MaiL����GeJ� �,-G.���y�{U��J����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,
s and state that all the informatio required is correct. I agree to ;Plumbing: $
' comply with the informatio nd ot plan to comply with all Town
ordinances and state la to b � is structure according ElectricaC $
I to the town's zoning a divi � n des, design �eview ap-
;; proved, Inter tiona ddin esidential Codes and other !:Mechanicaf: $
€ ordinances f own a icable thereto.
X ;Total: $�
Owner/Owner's Representat e Signature(Required) _.... ..............................................._......................................'
_....:............................................................................................................................................... Date Received:
�� C� [� [I �IC�,
For Office Ifse Onlv: � �T) )�t
Fee Paid: J�� �'° 3 4U��
Received From:
Cash Check# �A1 A
CC: Visa/MC Last 4 CC# exp.date: �o v y� �� �„��
Authorization#