HomeMy WebLinkAboutB15-0458_ �
� Department of Community Development
75 South Frontage Road
TOW1V QF VAIL ' va�i, CO 81657
Te1: 970-479-2139
www.vailgov.com
BUILDING PERMITAPPLICATION
(Separate applications are required for alarm &sprinkler)
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� Project Street Ad ess: `��''` � .,,�
I � _ ' Project#: �''i`, � � u� - �� �.��.%�_
' (Number) (Street) t7y�/f=�E�'l'(�'- C�'�(��- ` uite#) DRB#:
Building Permit#: �( � "` �� "l� �
�� Building/Complex Name: r� - ������ �
Contractor Information .
Lot#: �\�-Block# Subdivision:
Business Name: ���-V��.�-5 }-��S ��
Business Address:_��p�� �U.� c����� �,�'� Work Class: New( ) Addition( ) Alteration ( )
City �V��..� State:�Zip: r�� �Z � Type of Building: .
Contact Name:
U�r ^ � �C' � �Q Z Single-Family(�) Duplex( ) Multi-Family( )
Commercial ( ) Other( )
Contact Phone: � ' � � '
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Contact E-Mail: ���L' �1�, V� `� zLCe✓{�y�/ork Type: Interior(�) Exterior O Both O
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I hereby acknowledge that I have read this application,filled out Valuation of
' in full the information required,completed an accurate plot plan, 1I1/ork Included Plans Included Work
and state that all the information as required is correct. I agree to
comply with the information and plot plan,to comply with all Town ,Electrical ( )Yes ( )No Please submit
; ordinances and state laws, and to build this structure according to electrical permit
the town's zoning and subdivision odes, design review ap- application.
proved, International Building and esidential Codes and other
ordinances of the To applicab �thereto. Mechanical ( )Yes ( )No ( )Yes ( )No
a . ^
X Plumbing ( )Yes ( )No ( )Yes ( )No ',
Owner/Owner's Representa e Signature(Required) Building (�Yes ( )No ( )Yes ( )No � ��U
_ • _ _.
'Value of all work being performed: $ 1�2.�a `� �
I Applicant Informatio • ' (value based on IBC Section 109.3&IRC Section 108.3� �
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Applicant Name: �,��)� �� � 1!.� C�� ��, Detailed Scope and Location of Work: `�`�t?C-� ���C--
;Applicant Phone: �G � l[�t� c ��J1���/Y� ��-. �'�C�C%'�--.5 -�f�Qj�CENi.�t_
Applicant E-Mail: ��1� ��I�-�� l l.y , � �S ��S ��.L." 1 ; �,-�-��lh.)�1-�-- .
� ����Y�i'7�-�-`-�.��� 1 Tl�
Project Information \�{� ► 6 ��i 1 e�� ! � _
Owner Name: J rz Iv W
Parcel#: �� � ,� � ry�. � Ur� ����_
(For Parcel#,contact Eagle County Assessors Office at(970-328-8640 or visit
www.eaglecounty.us/patie)
(use additional sheet if necessary)
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For Office Use Only: - = t'>'' � �,� L� � l�. �� ��� �� �.
� �� ' Date Received: ' �� -- ��
Fee Paid: �'�._.' f
Received From: ��� 1 U 1�15 ;
Cash Check# �I; !{
CC: Visa/ MC Last 4 CC# exp date: � " '
Auth # ���� Q� ����._
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Rev.2015-Oct
PAYMENT DATE Town of Vail BATCH NO.
11/19/2015 75 South Frontage Road 2015-00000792
COLLECTION STATION Vail, CO 81657 RECEIPT NO.
Front Desk (970) 479-2100 2015-00007431
RECEIVED FROM CASHIER
EDUARDO SANCHEZ Andy Janusz
DESCRIPTION
PE RM IT#B 15-0458
• � � � ' ' •
Building Permit � Building Permits i $44.85
I Plan Check Fee I Plan Check Fee $29.15
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I Will Call Inspec I Will Call Inspection Fee $5.00
Payments: Type Detail Amount
Cash $100.00
Cash ($21.00)
Total Cash $100.00
Total Check $0.00
Total Charge $0.00
Total Other $0.00
Total Remitted $100.00
Change ($21.00)
Total Received $79.00
Total Amount: $79.00
Customer Copy
Printed by:Andy Janusz Page 1 of 1 11/19/2015 08:42:57 AM